《IHPBA-APHPBA临床实践指南:国际德尔菲胆囊癌共识推荐》解读  

Interpretation of the“IHPBA-APHPBA clinical practice guidelines’:International Delphi consensus recommendations for gallbladder cancer”

作　　者：何开举 吴向嵩[1] 龚伟[1] HE Kai-ju;WU Xiang-song;GONG Wei(Department of General Surgery,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Laboratory of Biliary Tract Disease,Shanghai Jiao Tong University School of Medicine,Shanghai Key Laboratory of Biliary Tract Disease Research,Shanghai Research Center for Biliary Tract Disease,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院普外科,上海交通大学医学院胆道疾病实验室,上海市胆道疾病研究重点实验室,上海市胆道疾病研究中心,上海200092

出　　处：《中国实用外科杂志》2025年第3期260-265,共6页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金项目(No.82172628,No.82173048,No.82373370);上海市卫生健康委员会卫生健康学科带头人项目(No.2022XD010);上海市科学技术委员会“科技创新行动计划”医学创新研究专项项目(No.22Y11908000)。

摘　　要：《IHPBA-APHPBA临床实践指南:国际德尔菲胆囊癌共识推荐》由国际肝胆胰协会(IHPBA)与亚太肝胆胰协会(APHPBA)组织全球45位专家通过德尔菲共识法制定,旨在为胆囊癌的临床实践提供统一规范。该指南重点围绕胆囊癌外科治疗争议、术语标准化及可切除性评估提出指导意见,并与国内外现有指南进行对比。胆囊癌的高危因素中,该指南强调膳食因素、环境污染物及胆石病的作用,但明确胆囊腺肌症并非风险因素,与国内指南存在分歧。对于无症状胆石病病人,共识不支持预防性胆囊切除术以降低胆囊癌风险,而国内指南则建议对高危病人实施择期手术。胆囊息肉治疗标准与国内指南一致:直径≥1 cm的息肉需手术切除,直径≥2 cm或伴可疑特征者术前需完善CT检查。病理学检查方面,该指南建议所有胆囊切除标本均应常规行病理学检查,以降低漏诊风险。手术命名与范围中,根治性胆囊癌切除术定义为肝切除联合肝十二指肠韧带淋巴结清扫;胆囊癌扩大根治术则涵盖大范围肝切除、肝外器官或血管切除等。对于意外胆囊癌,T1a期病人可观察,T1b期需再手术,但需结合病人全身状况评估手术风险。肝切除术范围根据分期决定:T2期可行肝楔形切除术,T3期存在肝楔形切除或肝Ⅳb~Ⅴ段整块切除的分歧。淋巴结清扫范围首次达成全球共识:T1b期及以上病人需行标准D2清扫(No.8、No.12、No.13a淋巴结),若腹主动脉旁淋巴结(No.16b1)转移则视为远处转移,放弃手术。微创手术仅推荐用于早期病例,晚期胆囊癌不建议常规施行微创手术。该共识首次提出临界可切除/局部进展期胆囊癌(BR/LA-GBC)的评估标准,包括肝门阻塞、淋巴结转移或血管侵犯等。正电子发射计算机断层扫描(PET/CT)被推荐用于局部进展期分期及新辅助治疗反应评估。对于转移性病例,共识推荐姑息性化疗,仅在必要时考虑姑息The“IHPBA-APHPBA clinical practice guidelines’:International Delphi consensus recommendations for gallbladder cancer”were developed by 45 global experts organized by the International Hepato-Pancreato-Biliary Association(IHPBA)and the Asia Pacific Hepato-Pancreato-Biliary Association(APHPBA)using the Delphi consensus method.The objective of these guidelines is to provide unified standards for clinical practice in gallbladder cancer.The guidelines focus on controversial issues on surgical treatment,the standardization of terminology,and resectability assessment,while comparing these recommendations to existing guidelines both domestically and internationally.Among the high-risk factors for gallbladder cancer,the consensus emphasizes the roles of dietary factors,environmental pollutants,and cholelithiasis,but clearly states that gallbladder adenomyomatosis is not a risk factor,which differs from domestic guidelines.For asymptomatic cholelithiasis patients,the consensus does not support prophylactic cholecystectomy to reduce the risk of gallbladder cancer,whereas domestic guidelines suggest elective surgery for high-risk patients.The treatment standards for gallbladder polyps are consistent with domestic guidelines:polyps with a diameter≥1 cm should be removed;those≥2 cm or with suspicious characteristics should undergo preoperative CT examination.Regarding pathological examination,the consensus recommends routine pathological examination for all gallbladder resection specimens to reduce the risk of misdiagnosis.In terms of surgical nomenclature and scope,radical cholecystectomy is defined as hepatectomy combined with lymphadenectomy of the hepatoduodenal ligament;extended radical cholecystectomy includes extensive hepatectomy and resection of extrahepatic organs or vessels.For incidental gallbladder cancer,patients with T1a stage can be observed,while those with T1b stage should undergo further surgery,but this decision should be based on the patient’s overall health condition.The extent of liver resect

关 键 词：胆囊癌 临床指南 Delphi共识 流行病学 胆囊息肉 根治性手术 局部进展期胆囊癌 

分 类 号：R6[医药卫生—外科学]