医源性胆管损伤术后长期生活质量分析

Long-Term Health-Related Quality-of-life assessment of Iatrogenic bile duct injury

目的有关胆囊切除医源性胆管损伤(IBDI)患者的长期生活质量(QOL)的报告极其有限.本研究的目的是对比分析IBDI患者在胆囊切除术前、IBDI期间和随访期间三个时间点的生活质量.方法收集了2001年1月1日至2017年12月31日期间在安徽医科大学第一附属医院和安徽省立医院进行多学科治疗的所有IBDI患者的临床资料.电话通知每位患者前往我中心门诊进行复查并当面指导填写QOL问卷.要求每位患者对比填写三个时间点的生活质量问卷.结果88位IBDI患者参与本研究,45位(51.0%)回应了QOL问卷.中位随访时间为60个月(IQR 14~173个月).78位(88.6%)表现为成功的长期临床结果.在IBDI期间,仅少数患者报告身体活动状态良好(24.4%)、情绪状态良好(35.5%)和一般健康状况良好(26.6%).经过多学科治疗后,患者随访期间的QOL明显得到改善:身体活动状态良好(93.3%)、情绪状态良好(91.1%)和一般健康状况良好(93.3%)(均p<0.05),并能恢复到胆囊切除术前状态:身体活动状态良好(95.5%)、情绪状态良好(82.2%)和一般健康状况良好(84.4%)(均P>0.05).未发现人口统计学和临床因素与改善的QOL有关.结论大部分(88.7%)IBDI患者在治疗后表现出成功的长期临床结果.与IBDI期间相比,IBDI患者随访期间的生活质量也得到明显改善,并能恢复到胆囊切除术前状态.

Objective Existing reports on the effects of iatrogenic bile duct injury(IBDI)on long-term health-related quality of life(HRQOL)are limited and conflicting.The purpose of this study was to compare the HRQOL of IBDI patients at three time points:pre-cholecystectomy,during IBDI,and during follow-up.Methods Clinical data on all IBDI patients who underwent multidisciplinary treatment at the First Affiliated Hospital of Anhui Medical University and Anhui Provincial Hospital from January 1,2001,to December 31,2017,were collected.All patients were contacted by telephone to visit our centre clinic for review and were instructed to complete the HRQOL questionnaire.All patients were asked to evaluate and compare HRQOL at three time points.Results Of the 88 patients with IBDI who participated in the study,45(51.0%)responded to the survey.The median follow-up time was 60 months(interquartile range 14 to 173 months).A total of 78(88.6%)patients presented with successful long-term clinical outcomes.During IBDI,only a few patients reported good physical(24.4%),mental(35.5%),and general(26.6%)health.After multidisciplinary treatment,these conditions significantly improved(good physical health:93.3%;good mental health:91.1%;good general health:93.3%;all P<0.05)and returned to the pre-cholecystectomy state(good physical health:95.5%;good mental health:82.2%;good general health:84.4%;all P>0.05).None of the demographic and clinical factors significantly predicted improved HRQOL in patients.Conclusions Most(88.7%)patients with IBDI showed successful long-term clinical outcomes after treatment.Compared with the IBDI period,the HRQOL of the IBDI patients during the follow-up period was significantly improved and returned to the precholecystectomy state.