Department of Pediatric General Surgery, Children's Hospital, Chongqing Medical University, Chongqing, 400014, People's Republic of China.
Department of Pediatric General Surgery, Chongqing Three Gorges Central Hospital, Chongqing, 400014, People's Republic of China.
Eur J Trauma Emerg Surg. 2022 Apr;48(2):1129-1135. doi: 10.1007/s00068-020-01553-4. Epub 2020 Nov 27.
Recently, single definitive hepaticojejunostomy has been proposed to replace two-stage procedures, including initial urgent biliary drainage and final biliary reconstruction, with a reduced hospitalization time and corresponding overall hospitalization cost. We aimed to investigate the safety and efficacy of the initial definitive operation compared with the two-stage approach.
The medical records of patients with perforated CDCs managed between 2010 and 2017 were retrospectively reviewed. The qualified samples were divided according to a single definitive operation or two-stage approach. We conducted a comparison of the clinical characteristics, including surgical parameters, length of stay, and short- and intermediate-term complications.
A total of 117 patients with perforated CDCs were reviewed, with 48 cases of single-stage management and 69 cases of two-stage management. No differences in the baseline characteristics between the two groups were found, such as age, sex distribution, ultrasound presentation, or laboratory findings. The initial definitive operation was associated with a lower total duration of drainage, including abdominal drainage and biliary drainage (p < 0.001), and rate of unplanned readmission (OR, 0.056; 95% CI 0.007-0.435; p < 0.001) than those who underwent two-stage management. Furthermore, the initial definitive operation significantly reduced the postoperative hospital stay (p < 0.001), and the overall hospitalization cost was accordingly reduced compared with two-stage management (p < 0.001).
The initial single definitive operation was safe and effective for most of the patients with perforated CDCs when expertise was available. Therefore, a single definitive operation should be considered the treatment of choice for perforated CDCs.
最近，有人提出单阶段确定性胆肠吻合术可以替代包括初始紧急胆道引流和最终胆道重建的两阶段手术，从而缩短住院时间并降低总住院费用。我们旨在研究与两阶段手术相比，初始确定性手术的安全性和疗效。
回顾性分析了 2010 年至 2017 年间接受治疗的穿孔性胆囊癌患者的病历。根据单阶段手术或两阶段手术将合格样本进行分组。比较了包括手术参数、住院时间以及短期和中期并发症在内的临床特征。
共回顾了 117 例穿孔性胆囊癌患者，其中 48 例行单阶段治疗，69 例行两阶段治疗。两组间的基线特征无差异，如年龄、性别分布、超声表现或实验室检查结果。与两阶段治疗相比，初始确定性手术的总引流时间（包括腹腔引流和胆道引流）更短（p<0.001），且计划外再入院率（OR，0.056；95%CI 0.007-0.435；p<0.001）也更低。此外，初始确定性手术显著缩短了术后住院时间（p<0.001），与两阶段治疗相比，总住院费用也相应降低（p<0.001）。
当专业知识可用时，初始单阶段确定性手术对大多数穿孔性胆囊癌患者是安全且有效的。因此，单阶段确定性手术应被视为穿孔性胆囊癌的治疗选择。
