Parkin Ed, Stott Martyn, Brockbank Joy, Galloway Simon, Welch Ian, Macdonald Andrew
Department of Upper Gastrointestinal Surgery, University Hospital of South Manchester, Manchester, UK.
Obesity and Cancer Research Group, Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK.
World J Surg. 2017 May;41(5):1234-1238. doi: 10.1007/s00268-016-3854-x.
A number of prominent surgical trials and clinical guidelines regard length of hospital stay and rates of daycase surgery as being of upmost importance following cholecystectomy. However, it is unclear whether these outcomes also matter to patients. This study aimed to identify the factors patients regard as most important when admitted with acute gallstone pathology.
A 41-item survey was produced by combining outcomes assessed in recent clinical trials with results from a preliminary patient questionnaire. This was then given out prospectively to patients presenting with acute gallstone pathology, prior to their cholecystectomy. Patients were asked to read an information sheet about laparoscopic cholecystectomy and then complete the survey, scoring each item out of 100 in terms of importance to them.
Fifty-six patients completed the survey (43 females; median age 51 years). Diagnoses were: cholecystitis (28 patients), biliary colic (13), pancreatitis (10), common bile duct stones (3) and cholangitis (2). The top-scoring survey item was "long-term quality of life after surgery", with a median value of 97 out of 100. Other high-scoring items included "cleanliness of the ward environment" and "pain control after surgery" (both 96). The lowest-scoring item was "being treated as a daycase" (54).
Patients with acute gallstone pathology view long-term quality of life after surgery as the most important factor and daycase surgery as the least important. These results should be considered when planning future surgical trials and clinical guidelines.
多项著名的外科手术试验和临床指南认为，胆囊切除术后的住院时间和日间手术率至关重要。然而，尚不清楚这些结果对患者是否也很重要。本研究旨在确定急性胆结石患者入院时认为最重要的因素。
通过将近期临床试验评估的结果与初步患者问卷的结果相结合，编制了一份包含41个项目的调查问卷。然后在患者进行胆囊切除术之前，将其前瞻性地分发给患有急性胆结石的患者。要求患者阅读一份关于腹腔镜胆囊切除术的信息表，然后完成调查问卷，就每个项目对他们的重要性给出100分制的评分。
56名患者完成了调查（43名女性；中位年龄51岁）。诊断结果为：胆囊炎（28例）、胆绞痛（13例）、胰腺炎（10例）、胆总管结石（3例）和胆管炎（2例）。得分最高的调查项目是“术后长期生活质量”，中位值为97分（满分100分）。其他得分较高的项目包括“病房环境清洁度”和“术后疼痛控制”（均为96分）。得分最低的项目是“作为日间手术患者接受治疗”（54分）。
急性胆结石患者认为术后长期生活质量是最重要的因素，而日间手术是最不重要的因素。在规划未来的外科手术试验和临床指南时应考虑这些结果。
