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首页> 外文期刊>Journal of hepato-biliary-pancreatic surgery >Assessing the appropriate use of laparoscopic surgery for hepatobiliary diseases.
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Assessing the appropriate use of laparoscopic surgery for hepatobiliary diseases.

机译：评估腹腔镜手术对肝胆疾病的适当使用。

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BACKGROUND: The range of indications for laparoscopic surgery has widened since it was first introduced. The aim of the present study was to develop standards for the appropriate use of laparoscopic surgery in patients with choledocholithiasis or cholelithiasis. METHOD: We conducted a study following the RAND appropriateness method (RAM) to develop criteria for hepatobiliary laparoscopy. A panel comprised of 7 experts rated the appropriateness of a set of indications, from 1 (very inappropriate) to 9 (very appropriate). The panelists performed ratings in 2 rounds. The first round was performed independently by every expert. The second round took place during a face-to-face meeting. According to the median of panelists' ratings and agreement criteria, every indication was classified as appropriate, uncertain, or inappropriate. RESULTS: In the first round, 112 (46.7%) indications were judged as appropriate, 102 (42.5%) as uncertain, and 26 (10.8%) as inappropriate. In the second round, 99 indications (48.5%) were considered as appropriate, 81 (39.7%) as uncertain, and 24 (11.8%) as inappropriate. Disagreement between panelists decreased in the second round compared with the first round. Thirteen indications were rated as disagreement (6.4%), 125 as uncertain (61.3%), and 66 as agreement (32.3%), while in the first round, the results and proportions were 44 (18.3%), 132 (55.0%), and 64 (26.7%), respectively. CONCLUSIONS: By using RAM, the panel was able to develop detailed explicit appropriateness criteria for the proper application of hepatobiliary laparoscopy. The criteria may be used prospectively to help in making clinical decisions or retrospectively to assess the overuse of clinical procedures.
机译：背景：自首次提出以来，腹腔镜手术的适应症范围已经扩大。本研究的目的是为在胆总管结石或胆石症患者中适当使用腹腔镜手术制定标准。方法：我们按照RAND适用性方法（RAM）进行了一项研究，以制定肝胆腹腔镜检查的标准。由7位专家组成的小组对一组适应症的适当性进行了评分，从1（非常不合适）到9（非常合适）。小组成员进行了两轮评分。第一轮比赛由每位专家独立进行。第二轮在面对面会议期间举行。根据小组成员评分和协议标准的中位数，将每种适应症分类为适当，不确定或不适当。结果：在第一轮中，有112例（46.7％）的适应症被判定为适当，有102例（42.5％）的判定为不确定，有26例（10.8％）的判定为不合适。在第二轮中，有99项适应症（48.5％）被认为是适当的，有81项（39.7％）被认为是不确定的，有24项（11.8％）被认为是不合适的。与第一轮相比，第二轮小组成员之间的分歧有所减少。十三种适应症的评分为异议（6.4％），125种不确定性（61.3％），66种符合性（32.3％），而在第一轮中，结果和比例为44（18.3％），132（55.0％） ，分别为64和（26.7％）。结论：通过使用RAM，该小组能够制定详细的明确适当性标准，以正确应用肝胆腹腔镜检查。该标准可以前瞻性地用于帮助做出临床决策，也可以用于评估临床程序的过度使用。

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