Acute calculus cholecystitis (ACC) has a high incidence in the general population. The presence of several areas of uncertainty, along with the availability of new evidence, prompted the current update of the 2016 WSES (World Society of Emergency Surgery) Guidelines on ACC. The WSES president appointed four members as a scientific secretariat, four members as an organization committee and four members as a scientific committee, choosing them from the expert affiliates of WSES. Relevant key questions were constructed, and the task force produced drafts of each section based on the best scientific evidence from PubMed and EMBASE Library; recommendations were developed in order to answer these key questions. The quality of evidence and strength of recommendations were reviewed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria (see https://www.gradeworkinggroup.org/ ). All the statements were presented, discussed and voted upon during the Consensus Conference at the 6th World Congress of the World Society of Emergency Surgery held in Nijmegen (NL) in May 2019. A revised version of the statements was voted upon via an online questionnaire until consensus was reached. The pivotal role of surgery is confirmed, including in high-risk patients. When compared with the WSES 2016 guidelines, the role of gallbladder drainage is reduced, despite the considerable technical improvements available. Early laparoscopic cholecystectomy (ELC) should be the standard of care whenever possible, even in subgroups of patients who are considered fragile, such as the elderly; those with cardiac disease, renal disease and cirrhosis; or those who are generally at high risk for surgery. Subtotal cholecystectomy is safe and represents a valuable option in cases of difficult gallbladder removal. ELC has a central role in the management of patients with ACC. The value of surgical treatment for high-risk patients should lead to a distinction between high-risk patients and patients who are not suitable for surgery. Further evidence on the role of clinical judgement and the use of clinical scores as adjunctive tools to guide treatment of high-risk patients and patients who are not suitable for surgery is required. The development of local policies for safe laparoscopic cholecystectomy is recommended.

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2020世界急诊外科学会更新急性结石性胆囊炎诊治指南

急性结石性胆囊炎（ACC）在普通人群中发病率较高。多个不确定领域的存在以及新证据的出现促使当前更新 2016 年 WSES（世界急诊外科学会）ACC 指南。WSES主席从WSES的专家附属机构中任命了四名成员作为科学秘书处、四名成员作为组织委员会和四名成员作为科学委员会。构建了相关的关键问题，工作组根据 PubMed 和 EMBASE 图书馆的最佳科学证据制定了每个部分的草稿；制定建议是为了回答这些关键问题。使用建议评估、制定和评估分级 (GRADE) 标准对证据质量和建议强度进行了审查（参见 https://www.gradeworkinggroup.org/ ）。所有声明均于 2019 年 5 月在荷兰奈梅亨举行的世界急诊外科学会第六届世界大会共识大会上提出、讨论和投票。声明的修订版本通过在线调查问卷进行投票，直至达成了共识。手术的关键作用得到证实，包括在高危患者中。与 WSES 2016 指南相比，尽管已有相当大的技术改进，但胆囊引流的作用有所减弱。只要有可能，早期腹腔镜胆囊切除术 (ELC) 应成为标准治疗，即使是对于老年人等被认为脆弱的患者亚组；患有心脏病、肾病和肝硬化的人；或那些通常处于手术高风险的人。胆囊次全切除术是安全的，在胆囊切除困难的情况下是一种有价值的选择。ELC 在 ACC 患者的治疗中发挥着核心作用。手术治疗对高危患者的价值应导致高危患者和不适合手术的患者之间的区别。需要进一步证据证明临床判断的作用以及使用临床评分作为辅助工具来指导高危患者和不适合手术的患者的治疗。建议制定安全腹腔镜胆囊切除术的地方政策。