ヒグチ　リヨウタ   HIGUCHI Ryota   樋口　亮太    所属   医学部 医学科（附属八千代医療センター）    職種   講師
論文種別	原著
言語種別	英語
査読の有無	査読なし
表題	Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis.
掲載誌名	正式名：Journal of hepato-biliary-pancreatic sciences 略　 称：J Hepatobiliary Pancreat Sci ISSNコード：(1868-6982)1868-6974(Linking)
掲載区分	国内
巻・号・頁	25(1),pp.55-72
著者・共著者	OKAMOTO Kohji,SUZUKI Kenji,TAKEDA Tadahiro,Strasberg Steven M,Asbun Horacio J,ENDO Itaru,IWASHITA Yukio,HIBI Taizo,Pitt Henry A,UMEZAWA Akiko,ASAI Koji,Han Ho-Seong,Hwang Tsann-Long,MORI Yasuhisa,Yoon Yoo-Seok,Huang Wayne Shih-Wei,Belli Giulio,Dervenis Christos,YOKOE Masamichi,KIRIYAMA Seiki,ITOI Takao,Jagannath Palepu,Garden O James,MIURA Fumihiko,NAKAMURA Masafumi,HORIGUCHI Akihiko,WAKABAYASHI Go,Cherqui Daniel,de Santibañes Eduardo,SHOKATA Satoru,NOGUCHI Yoshinori,UKAI Tomohiko,HIGUCHI Ryota,WADA Keita,HONDA Goro,Supe Avinash Nivritti,YOSHIDA Masahiro,MAYUMI Toshihiko,Gouma Dirk J,Deziel Daniel J,Liau Kui-Hin,Chen Miin-Fu,SHOBAO Kazunori,Liu Keng-Hao,Su Cheng-Hsi,Chan Angus C W,Yoon Dong-Sup,Choi In-Seok,Jonas Eduard,Chen Xiao-Ping,Fan Sheung Tat,Ker Chen-Guo,Giménez Mariano Eduardo,KITANO Seigo,INOMATA Masafumi,HIRATA Koichi,INUI Kazuo,SUMIYAMA Yoshinobu,YAMAMOTO Masakazu
発行年月	2018/01
概要	We propose a new flowchart for the treatment of acute cholecystitis (AC) in the Tokyo Guidelines 2018 (TG18). Grade III AC was not indicated for straightforward laparoscopic cholecystectomy (Lap-C). Following analysis of subsequent clinical investigations and drawing on Big Data in particular, TG18 proposes that some Grade III AC can be treated by Lap-C when performed at advanced centers with specialized surgeons experienced in this procedure and for patients that satisfy certain strict criteria. For Grade I, TG18 recommends early Lap-C if the patients meet the criteria of Charlson comorbidity index (CCI) ≤5 and American Society of Anesthesiologists physical status classification (ASA-PS) ≤2. For Grade II AC, if patients meet the criteria of CCI ≤5 and ASA-PS ≤2, TG18 recommends early Lap-C performed by experienced surgeons; and if not, after medical treatment and/or gallbladder drainage, Lap-C would be indicated. TG18 proposes that Lap-C is indicated in Grade III patients with strict criteria. These are that the patients have favorable organ system failure, and negative predictive factors, who meet the criteria of CCI ≤3 and ASA-PS ≤2 and who are being treated at an advanced center (where experienced surgeons practice). If the patient is not considered suitable for early surgery, TG18 recommends early/urgent biliary drainage followed by delayed Lap-C once the patient's overall condition has improved. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
DOI	10.1002/jhbp.516
PMID	29045062