de Reuver P R, Sprangers M A, Rauws E A, Lameris J S, Busch O R, van Gulik T M, Gouma D J
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Endoscopy. 2008 Aug;40(8):637-43. doi: 10.1055/s-2008-1077444.
Bile duct injury (BDI) is associated with increased morbidity and poor survival. The aim of the present study was to compare quality of life (QoL) between patients with BDI and those without after laparoscopic cholecystectomy. A longitudinal assessment was performed and risk factors for poor QoL were determined.
In March 2005 a survey was performed of 403 eligible patients with BDI who were referred to a tertiary center for multidisciplinary treatment by gastroenterologists, radiologists, and surgeons. A longitudinal quality-of-life study was performed to determine changes in outcome after a mean of 5.5 and 11 years' follow-up.
Of the eligible 403 patients with BDI, 278 (69 %) responded to the survey after a mean follow-up of 5.9 years. The quality-of-life outcome of injured patients was significantly lower in three of the eight domains compared to patients who underwent cholecystectomy without an injury ( P < 0.05). In seven of the eight QoL domains injured patients scored significantly worse than the healthy population norms ( P < 0.05). The longitudinal assessment after another 5.5 years of follow-up did not show improvement in QoL. Clinical characteristics such as the type of injury and the type of treatment did not affect outcome. Nineteen percent of the patients (n = 53) filed a malpractice claim after BDI. These patients reported better QoL (effect size = 0.6, P = 0.02) when the claim was resolved in their favor than when the claim was rejected.
BDI has a detrimental effect on long-term QoL. QoL in patients with BDI is poor and does not improve during follow-up. The outcome of a malpractice litigation claim is associated with QoL.
胆管损伤（BDI）与发病率增加及生存率降低相关。本研究旨在比较腹腔镜胆囊切除术后胆管损伤患者与未发生胆管损伤患者的生活质量（QoL）。进行了纵向评估并确定了生活质量差的危险因素。
2005年3月，对403例符合条件的胆管损伤患者进行了调查，这些患者由胃肠病学家、放射科医生和外科医生转诊至三级中心接受多学科治疗。进行了一项纵向生活质量研究，以确定平均随访5.5年和11年后的结果变化。
在403例符合条件的胆管损伤患者中，278例（69%）在平均随访5.9年后对调查做出了回应。与未发生损伤的胆囊切除术患者相比，损伤患者在八个领域中的三个领域的生活质量结果显著更低（P<0.05）。在八个生活质量领域中的七个领域，损伤患者的得分显著低于健康人群标准（P<0.05）。在另外5.5年的随访后的纵向评估未显示生活质量有所改善。损伤类型和治疗类型等临床特征不影响结果。19%的患者（n = 53）在胆管损伤后提起了医疗事故索赔。当索赔得到有利于他们的解决时，这些患者报告的生活质量更好（效应大小 = 0.6，P = 0.02），而当索赔被驳回时则不然。
胆管损伤对长期生活质量有不利影响。胆管损伤患者的生活质量较差，且在随访期间没有改善。医疗事故诉讼索赔的结果与生活质量相关。
