新Q1 鈴木先生 - jshbps.jp

1 Q1 . 8. Lap-C safety Safe steps in laparoscopic cholecystectomy for acute cholecystitis (0330_record). TG13 surgical management of acute cholecystitis Q1 . Is laparoscopic cholecystectomy recommended for acute cholecystitis? Key Words Laparoscopic cholecystectomy, open cholecystectomy, acute cholecystitis Foreground Question Clinical Question .. 1. / A . 1 . SR 25958296 4 RCT. 24634923 17366000 15584058 9652612 5 OS 8480927. 10370605 9348622 8211618 11395823 .. (95% . ) . Figure 2 Cost 1 QOL .. Population-based cohort study USA NIS(Nationwide Inpatient Sample) . 1998 83 135447 /163183 2005 93 170530.

2 /183767 OS 18656637 Canada Ontario 2004. 2011 22202 21280 . OS 23979286 Sweden . Swedish Registry of Gallstone Surgery and Endoscopic Retrograde Cholangiography(GallRiks) 2006 2014 . 15760 12522 79 . OS 27649704 . 4,211 2,728 % . ( %) OS .. (1)Coccolini F, Catena F, Pisano M, Gheza F, Fagiuoli S, Di Saverio S, Leandro G, Montori G, Ceresoli M, Corbella D, Sartelli M, Sugrue M, Ansaloni L. Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analysis. Int J Surg. 2015 Jun;18:196-204. PMID:25958296. (2)Catena F, Ansaloni L, Bianchi E, Di Saverio S, Coccolini F, Vallicelli C, Lazzareschi D, Sartelli M, Amaduzzi A, Amaduzz A, Pinna AD.

3 The ACTIVE (Acute Cholecystitis Trial Invasive Versus Endoscopic). Study: multicenter randomized, double-blind, controlled trial of laparoscopic versus open surgery for acute cholecystitis. Hepatogastroenterology. 2013 Oct;60(127):1552-6. PMID:24634923. (3)Boo YJ, Kim WB, Kim J, Song TJ, Choi SY, Kim YC, Suh SO. Systemic immune response after open versus laparoscopic cholecystectomy in acute cholecystitis: a prospective randomized study. Scand J Clin Lab Invest. 2007;67(2):207-14. PMID:17366000. (4)Johansson M, Thune A, Nelvin L, Stiernstam M, Westman B, Lundell L. Randomized clinical trial of open versus laparoscopic cholecystectomy in the treatment of acute cholecystitis.

4 Br J Surg. 2005 Jan;92(1):44-9. PMID:15584058. (5)Kiviluoto T, Sir n J, Luukkonen P, Kivilaakso E. Randomised trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis. Lancet. 1998 Jan 31;351(9099):321-5. PMID:9652612. (6) Kelley JE, Burrus RG, Burns RP, Graham LD, Chandler KE. Safety, efficacy, cost, and morbidity of laparoscopic versus open cholecystectomy: a prospective analysis of 228 consecutive patients. Am Surg. 1993 Jan;59(1):23-7. PMID:8480927. (7)Koperna T, Kisser M, Schulz F. Laparoscopic versus open treatment of patients with acute cholecystitis.

5 Hepatogastroenterology. 1999 Mar-Apr;46(26):753-7. PMID:10370605. (8)Eldar S, Sabo E, Nash E, Abrahamson J, Matter I. Laparoscopic versus open cholecystectomy in acute cholecystitis. Surg Laparosc Endosc. 1997 Oct;7(5):407-14. PMID:9348622. (9)Unger SW, Rosenbaum G, Unger HM, Edelman DS. A comparison of laparoscopic and open treatment of acute cholecystitis. Surg Endosc. 1993 Sep-Oct;7(5):408-11. PMID:8211618. (10)Glavic Z, Begic L, Simlesa D, Rukavina A. Treatment of acute cholecystitis. A comparison of open vs laparoscopic cholecystectomy. Surg Endosc. 2001 Apr;15(4):398-401. PMID:11395823.

6 (11)Csikesz NG, Tseng JF, Shah SA. Trends in surgical management for acute cholecystitis. Surgery. 2008 Aug;144(2):283-9. PMID:18656637. (12)Comparative operative outcomes of early and delayed cholecystectomy for acute cholecystitis: a population-based propensity score analysis. de Mestral C, Rotstein OD, Laupacis A, Hoch JS, Zagorski B, Alali AS, Nathens AB. Ann Surg. 2014 Jan;259(1):10-5. PMID:23979286. (13)Blohm M, sterberg J, Sandblom G, Lundell L, Hedberg M, Enochsson L. The Sooner, the Better? The Importance of Optimal Timing of Cholecystectomy in Acute Cholecystitis: Data from the National Swedish Registry for Gallstone Surgery, GallRiks.

7 J Gastrointest Surg. 2017 Jan;21(1):33-40. PMID:27649704. 3-4 CQ1 . Key Clinical Issue .. merit,demerit . CQ . P Patients, Problem, Population .. I Interventions C Comparisons, Controls . / . O Outcomes . Outcome . O1 9 . O2 7 . O3 5 . O4 QOL 5 . O5 Cost 5 . O6 . O7 . O8 . O9 . O10 . CQ. Which surgical procedure is preferred, laparoscopic cholecystectomy or open cholecystectomy? 4-5 CQ1 . TG TG13 . acute cholecystitis * " -2 " " / -1 " " 0 " 3 . " -2 " " -1 " " 0 " 3 . laparoscopic cholecystectomy . open cholecystectomy . *.. * .. ITT ( ) ( ) . ( . ( ). ).. 24634923 RCT -2 -2 -1 -1 -2 -1 -2 -2 -2 -1 -2 -2 -2 -2 -2 72 NR 72 NR.

8 15584058 RCT -1 -1 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 35 0 0 35 0 0. 17366000 RCT -2 -1 -1 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 18 NR 15 NR. 9652612 RCT -1 -1 -1 -1 -2 -2 -2 -2 -2 -1 -2 -2 -2 -2 -2 32 32 0 31 0 0.. maski . ng . compu . ter .. compu maski ter ng . 4-5 CQ1 . TG TG13 . acute cholecystitis * " -2 " " / -1 " " 0 " 3 . " -2 " " -1 " " 0 " 3 . laparoscopic cholecystectomy . open cholecystectomy . *.. * .. ITT ( ) ( ) . ( . ( ). ).. 24634923 RCT -2 -2 -1 -1 -2 -1 -2 -2 -2 -1 -2 -2 -2 -2 -2 72 25 72 24 ns 15584058 RCT -1 -1 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 35 2 35 3 17366000 RCT -2 -1 -1 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 18 0 0 15 2 9652612 RCT -1 -1 -1 -1 -2 -2 -2 -2 -2 -1 -2 -2 -2 -2 -2 32 1 31 13.

9 Maski . ng . compu . ter .. compu maski ter ng . 4-5 CQ1 . TG TG13 . acute cholecystitis * " -2 " " / -1 " " 0 " 3 . " -2 " " -1 " " 0 " 3 . laparoscopic cholecystectomy . open cholecystectomy . *.. * .. ITT ( ) ( ) . ( . ( ). ).. 24634923 RCT -2 -2 -1 -1 -2 -1 -2 -2 -2 -1 -2 -2 -2 -2 -2 72 72 15584058 RCT -1 -1 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 35 2(1-10) 35 2(1-8). 17366000 RCT -2 -1 -1 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 18 15 9652612 RCT -1 -1 -1 -1 -2 -2 -2 -2 -2 -1 -2 -2 -2 -2 -2 32 4(2-5) 31 6 5-8).. maski . mean mean ng . compu media media ter n(rang n(rang .. compu maski media media ter ng n(IQR) n(IQR).)

10 4-5 CQ1 . TG TG13 . acute cholecystitis * " -2 " " / -1 " " 0 " 3 . " -2 " " -1 " " 0 " 3 . laparoscopic cholecystectomy . open cholecystectomy Cost total . *.. * .. ITT ( ) ( ) . ( . ( ). ).. 24634923 RCT -2 -2 -1 -1 -2 -1 -2 -2 -2 -1 -2 -2 -2 -2 -2 72 NR 72 NR. 15584058 RCT -1 -1 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 35 3503 35 3218 . 17366000 RCT -2 -1 -1 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 18 NR 15 NR. 9652612 RCT -1 -1 -1 -1 -2 -2 -2 -2 -2 -1 -2 -2 -2 -2 -2 32 NR 31 NR.. maski . ng . compu . ter . compu . ter . compu maski ter ng . 4-6 CQ1 .. acute cholecystits * . " -2 " " / -1 " " 0 " 3.