使用改良手风琴法、解剖学、时间和机制分类法对主要胆管损伤胆管重建术后早期并发症的分析
An analysis of early postoperative complications following biliary reconstruction of major bile duct injuries using the Modified Accordion and Anatomic, Timing Of and Mechanism classifications.
作者信息
Lindemann Jessica, Jonas Eduard, Kotze Urda, Krige Jake Ej
机构信息
Department of Surgery, University of Cape Town Health Sciences Faculty, Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town, South Africa.
Department of Surgery, Washington University School of Medicine, Saint Louis, MO.
出版信息
Surg Open Sci. 2019 Mar 3;1(1):2-6. doi: 10.1016/j.sopen.2019.01.001. eCollection 2019 Jul.
BACKGROUND
Few studies have reported patient outcome after surgical repair of bile duct injury using a standardized, validated classification system. This is the first analysis to investigate the correlation between the Anatomic, Timing Of and Mechanism classification of bile duct injury and severity of postoperative complications classified using the Modified Accordion Grading System.
METHODS
Patients undergoing index hepaticojejunostomy repair of bile duct injury in laparoscopic cholecystectomy at a tertiary referral center from 1993-2018 were included. Patient demographics, geographic distance from referral center, time to referral, Anatomic, Timing Of and Mechanism classification and highest Modified Accordion Grade complication were retrieved from a prospective database. The primary outcome was determined using correlation statistics to assess the relationship between level of injury and severity of postoperative complication.
RESULTS
One hundred and twenty-eight patients were included. There was no correlation between level of injury and severity of postoperative complication ( (128) = -0.113, P = .203). Seventy (54.7%) patients had an injury less than 2 cm from the hepatic duct bifurcation and 52% of patients developed a postoperative complication, most mild to moderate in severity. Geographic distance resulted in substantial delays in referral (P < .001) but did not affect complication rate (P = .523).
CONCLUSION
In this prospective analysis the short-term complication rate was higher than previous retrospective reports, but the distribution of the severity of complications and spectrum of injury type were similar. There was no correlation between severity of injury and postoperative complications. Geographic distance from referral center resulted in substantial differences in referral delay but had no statistically significant effect on outcome.
背景
很少有研究使用标准化、经过验证的分类系统报告胆管损伤手术修复后的患者预后。这是第一项分析胆管损伤的解剖学、时间和机制分类与使用改良手风琴分级系统分类的术后并发症严重程度之间相关性的研究。
方法
纳入1993年至2018年在一家三级转诊中心接受腹腔镜胆囊切除术中胆管损伤初次肝空肠吻合修复的患者。从一个前瞻性数据库中检索患者的人口统计学资料、距转诊中心的地理距离、转诊时间、解剖学、时间和机制分类以及最高改良手风琴分级并发症。主要结局通过相关性统计分析来评估损伤程度与术后并发症严重程度之间的关系。
结果
共纳入128例患者。损伤程度与术后并发症严重程度之间无相关性（r(128)=-0.113，P=0.203）。70例（54.7%）患者的损伤距肝管分叉小于2 cm，52%的患者发生了术后并发症，大多数为轻至中度。地理距离导致转诊出现显著延迟（P<0.001），但不影响并发症发生率（P=0.523）。
结论
在这项前瞻性分析中，短期并发症发生率高于以往的回顾性报告，但并发症严重程度的分布和损伤类型谱相似。损伤严重程度与术后并发症之间无相关性。距转诊中心的地理距离导致转诊延迟存在显著差异，但对结局无统计学显著影响。
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