肝空肠吻合术修复胆管损伤后的生活质量：一项全国队列研究。

Quality-of-life after bile duct injury repaired by hepaticojejunostomy: a national cohort study.

作者信息

Sturesson Christian, Hemmingsson Oskar, Månsson Christopher, Sandström Per, Strömberg Cecilia, Taflin Helena, Rystedt Jenny

机构信息

Division of Surgery, Department of Clinical Science, Intervention and Technology, (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.

Department of Surgical And Perioperative Sciences, Umeå University, Umeå, Sweden.

出版信息

Scand J Gastroenterol. 2020 Sep;55(9):1087-1092. doi: 10.1080/00365521.2020.1800076. Epub 2020 Jul 31.

DOI:10.1080/00365521.2020.1800076

PMID:32735151

Abstract

OBJECTIVES

Reports on quality-of-life (QoL) after bile duct injury (BDI) show conflicting results. The aim of this cohort study was to evaluate QoL stratified according to type of treatment.

METHODS

QoL assessment using the SF-36 (36-item short form health survey) questionnaire. Patients with post-cholecystectomy BDI needing hepaticojejunostomy (HJ) were compared to all other treatments (BDI repair) and to patients without BDI at cholecystectomy (controls).

RESULTS

Patients needing a HJ after BDI reported reduced long-term QoL irrespective of time for diagnosis and repair in both the physical (PCS; < .001) and mental (MCS; < .001) domain compared to both controls and patients with less severe BDI. QoL was comparable for BDI repair ( = 86) and controls ( = 192) in both PCS ( = .171) and MCS ( = .654). As a group, patients with BDI ( = 155) reported worse QoL than controls, in both the PCS ( < .001) and MCS ( = .012). Patients with a BDI detected intraoperatively ( = 124) reported better QoL than patients with a postoperative diagnosis. Patients with an immediate intraoperative repair ( = 99), including HJ, reported a better long-term QoL compared to patients subjected to a later procedure ( = 54).

CONCLUSIONS

Patients with postoperative diagnosis and patients with BDIs needing biliary reconstruction with HJ both reported reduced long-term QoL.

摘要

目的

关于胆管损伤（BDI）后生活质量（QoL）的报告结果相互矛盾。本队列研究的目的是根据治疗类型对生活质量进行分层评估。

方法

使用SF-36（36项简短健康调查问卷）进行生活质量评估。将胆囊切除术后需要肝空肠吻合术（HJ）的BDI患者与所有其他治疗方法（BDI修复）以及胆囊切除术中无BDI的患者（对照组）进行比较。

结果

与对照组和BDI较轻的患者相比，BDI后需要进行HJ的患者在身体（PCS；<0.001）和心理（MCS；<0.001）领域的长期生活质量均有所下降，且与诊断和修复时间无关。BDI修复组（n = 86）和对照组（n = 192）在PCS（P = 0.171）和MCS（P = 0.654）方面的生活质量相当。总体而言，BDI患者（n = 155）在PCS（<0.001）和MCS（P = 0.012）方面的生活质量均比对照组差。术中检测到BDI的患者（n = 124）的生活质量优于术后诊断的患者。与接受后期手术的患者（n = 54）相比，立即进行术中修复（包括HJ）的患者（n = 99）报告的长期生活质量更好。