Department of Surgery, Universidad de La Frontera, M. Montt 112, Office 408, Temuco, Chile.
World J Surg. 2010 Mar;34(3):581-6. doi: 10.1007/s00268-009-0322-x.
The aim of this study was to determine if intrabiliary rupture (IBR), an evolutive complication of hepatic echinococcosis (HE), is a risk factor for developing postoperative morbidity (POM).
This was a concurrent cohort study that included patients operated on for HE between 1996 and 2006 and who had clinical check-ups at 1, 6, 12, 24, 36, 48, and 60 months postoperatively. Principal outcome variable was "development POM," considered dichotomously. The exposure variable was the presence of IBR, analyzed dichotomously (present or absent) and according to the number of IBR (without, with one, and with two or more). The sample size was considered on the basis of a 95% confidence interval (95% CI), a power of 80%, a 1:2 ratio of patients without and with IBR, and a 10% proportion of POM in patients without IBR and 26% in patients with IBR. Descriptive statistics and bivariate and multivariate analyses were used. Relative risks (RR) and 95% CI were calculated.
The cohorts (median age of 42 years, 56.4% female, a median cyst diameter of 15 cm, and a follow-up of 118 months) were composed of 96 patients without IBR (38.1%) and 156 patients with IBR (61.9%). A morbidity rate of 17.1% was verified (9.4% in the group without IBR and 21.8% in the group with IBR [p = 0.011]). An adjusted RR of 3.4 (95% CI = 2.64, 4.18) was verified for the comparison of subgroups without IBR vs. with two or more IBR (p < 0.001).
The presence of two or more IBR constitutes a risk factor for developing POM in patients with HE.
本研究旨在确定胆内破裂（IBR），肝包虫病（HE）的一种进展性并发症，是否是术后发病率（POM）的危险因素。
这是一项同期队列研究，纳入了 1996 年至 2006 年间接受 HE 手术且术后 1、6、12、24、36、48 和 60 个月进行临床检查的患者。主要结局变量为“发生 POM”，以二项式表示。暴露变量为 IBR 的存在，以二项式（存在或不存在）和根据 IBR 的数量（无、一个和两个或更多）进行分析。根据 95%置信区间（95%CI）、80%的置信度、无 IBR 与有 IBR 的患者比例为 1:2 以及无 IBR 患者 POM 比例为 10%和有 IBR 患者 POM 比例为 26%，计算样本量。使用描述性统计和双变量及多变量分析。计算相对风险（RR）和 95%CI。
队列（中位年龄 42 岁，56.4%为女性，中位囊肿直径 15cm，随访 118 个月）由 96 例无 IBR（38.1%）和 156 例有 IBR（61.9%）患者组成。验证了发病率为 17.1%（无 IBR 组为 9.4%，有 IBR 组为 21.8%[p=0.011]）。在无 IBR 组与有 2 个或更多 IBR 组之间比较，验证了 RR 为 3.4（95%CI=2.64,4.18）（p<0.001）。
有 2 个或更多 IBR 的存在是 HE 患者发生 POM 的危险因素。
