转变儿童胆总管结石的范例：在三级儿童医院制定手术优先的临床实践指南

IF 1.4 3区医学 Q3 PEDIATRICS

Seminars in Pediatric Surgery Pub Date : 2025-07-01 DOI:10.1016/j.sempedsurg.2025.151496

Meredith A. Achey , Jessica K. Sims , Jordan Busing , Sari Acra , Anthony Gamboa , J. Andres Martinez , Rekha Krishnasarma , Jessica L. Rauh , Lucas P. Neff , Irving J. Zamora

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引用次数: 0

摘要

儿童胆总管结石的传统治疗方法是先行两阶段内镜（EF），包括ERCP，然后进行胆囊切除术。这种策略增加了住院时间（LOS）、手术复杂性和麻醉暴露。越来越多的证据支持手术优先（SF）模式。方法某三级儿科中心的一个多学科团队于2023年制定了临床实践指南（CPG），使用儿科导管评分对患者进行风险分层，并优先考虑早期手术咨询。该指导意见于2024年4月进行了非正式试点，并于2025年1月正式实施。结果CPG强调早期转诊至儿科外科和术前腹腔镜胆囊切除术，术中胆管造影（IOC）和胆总管探查（LCBDE）。初步经验表明，对磁共振胆管造影（MRCP）的依赖减少，单阶段决定性治疗的采用增加。结论手术先入路治疗小儿胆总管结石安全、可行、有效。基于有效标准的结构化临床实践指南的机构实施，使胆道疾病儿童的高价值、流线型护理成为可能。

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Shifting the pediatric choledocholithiasis paradigm: Development of a surgery-first clinical practice guideline at a tertiary children’s hospital

Background

Pediatric choledocholithiasis has traditionally been managed with a two-stage endoscopy-first (EF) approach involving ERCP followed by cholecystectomy. This strategy increases hospital length of stay (LOS), procedural complexity, and exposure to anesthesia. A growing body of evidence supports a surgery-first (SF) paradigm.

Methods

A multidisciplinary team at a tertiary pediatric center developed a clinical practice guideline (CPG) in 2023 using the Pediatric DUCT score to risk-stratify patients and prioritize early surgical consultation. The guideline was informally piloted in April 2024 and formally implemented in January 2025.

Results

The CPG emphasizes early referral to pediatric surgery and upfront laparoscopic cholecystectomy with intraoperative cholangiography (IOC) and common bile duct exploration (LCBDE) when indicated. Preliminary experience has demonstrated reduced reliance on magnetic resonance cholangiopancreatogphy (MRCP) and increased adoption of single-stage definitive management.

Conclusions

A surgery-first approach for choledocholithiasis is safe, feasible, and effective in pediatric patients. Institutional implementation of structured clinical practice guidelines based on validated criteria, enables high-value, streamlined care of children with biliary disease.

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来源期刊

Seminars in Pediatric Surgery PEDIATRICS-SURGERY

CiteScore

2.80

自引率

5.90%

发文量

审稿时长

>12 weeks

期刊介绍： Seminars in Pediatric Surgery provides current state-of-the-art reviews of subjects of interest to those charged with the surgical care of young patients. Each bimontly issue addresses a single topic with articles written by the experts in the field. Guest editors, all noted authorities, prepare each issue.