Hepatobiliary and Pancreatic Surgery Unit, University Hospitals Birmingham, Birmingham, United Kingdom.
Institute of Translational Medicine, University Hospitals Birmingham, Birmingham, United Kingdom.
Surgery. 2020 Jun;167(6):942-949. doi: 10.1016/j.surg.2020.01.022. Epub 2020 Mar 14.
Outcomes after Strasberg grade E bile duct injury have been widely reported. However, there are comparatively few reports of outcomes after Strasberg A to D bile duct injury. Therefore, the aim of this study was to comprehensively evaluate the long-term clinical and economic impact of Strasberg A to D bile duct injury.
Patients with Strasberg A to D bile duct injury were identified from a prospectively collected and maintained database. Long-term biliary complication rates, as well as treatment costs were then estimated, and compared across Strasberg injury grades.
A total of N = 120 patients were identified, of whom N = 49, 13, 20, and 38 had Strasberg grade A, B, C, and D bile duct injury, respectively. Surgical repair was most commonly performed in Strasberg grade D injuries (74% vs 8%-20% in lower grades, P < .001). By 5 years post bile duct injury, the estimated long-term biliary complication rate was 40% in Strasberg grade D injuries, compared with 15% in Strasberg grade A (P = .022). A significant difference in total treatment and follow-up costs was also detected (P < .001), being highest in Strasberg grade D injuries (mean £11,048/US$14,252 per patient) followed by the Strasberg grade B group (mean £10,612/US$13,689 per patient).
Strasberg grade A to D injuries lead to considerable long-term morbidity and cost. Strasberg grade D injuries are typically managed surgically and result in the highest complication rate and treatment costs. Strasberg grade B injuries lead to a similar complication rate and treatment cost but are often managed without surgery.
Strasberg 分级 E 级胆管损伤的结果已被广泛报道。然而，Strasberg A 至 D 级胆管损伤的结果报告相对较少。因此，本研究旨在全面评估 Strasberg A 至 D 级胆管损伤的长期临床和经济影响。
从一个前瞻性收集和维护的数据库中确定 Strasberg A 至 D 级胆管损伤的患者。然后估计长期胆道并发症的发生率以及治疗费用，并在 Strasberg 损伤等级之间进行比较。
共确定了 120 例患者，其中 Strasberg 分级 A、B、C 和 D 的患者分别为 49、13、20 和 38 例。手术修复最常用于 Strasberg 分级 D 损伤（74%比低级别损伤的 8%-20%，P <.001）。在胆管损伤后 5 年，Strasberg 分级 D 损伤的长期胆道并发症发生率估计为 40%，而 Strasberg 分级 A 损伤为 15%（P =.022）。还检测到总治疗和随访费用的显著差异（P <.001），Strasberg 分级 D 损伤最高（每位患者平均 11,048 英镑/14,252 美元），其次是 Strasberg 分级 B 组（每位患者平均 10,612 英镑/13,689 美元）。
Strasberg A 至 D 级损伤导致相当大的长期发病率和费用。Strasberg 分级 D 损伤通常需要手术治疗，导致最高的并发症发生率和治疗费用。Strasberg 分级 B 损伤导致类似的并发症发生率和治疗费用，但通常无需手术治疗。
