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1.
目的:评估在中国这样一个人口众多、医疗资源相对不足的国家推广日间腹腔镜胆囊切除术(day-care laparo-scopic cholecystectomy,DCLC)的可行性,总结其短期临床疗效及对生活质量的影响。方法:2009年9月1日至2010年3月31日共纳入167例患者,依据所在医院分别行DCLC(DCLC组)及常规腹腔镜胆囊切除术(conventional laparoscopic cholecystecto-my,CLC)(CLC组)。记录手术相关情况及术后并发症。采用SF-36和消化系统疾病生活质量(gastrointestinal quality of life in-dex,GIQLI)量表分别于术前、术后2周及术后1个月记录患者生活质量。结果:两组患者年龄、性别、体重指数、ASA评分、手术指征、手术时间、出血量及术后并发症等差异无统计学意义(P>0.05)。研究期间无二次入院患者。术前、术后2周及术后1个月两组患者SF-36及GIQLI各维度差异亦无统计学意义(P>0.05)。住院时间及扣除耗材费用后的住院费用DCLC组显著优于CLC组(P<0.05)。结论:DCLC安全有效,可缩短住院时间、降低住院费用,在生活质量方面与CLC相比差异无统计学意义,日间手术在中国推行是可行的。 相似文献
2.
Quintana JM Cabriada J Aróstegui I López de Tejada I Bilbao A 《Surgical endoscopy》2003,17(7):1129-1134
BACKGROUND: Few studies have assessed the health outcomes of patients who underwent cholecystectomy. The goal of this study was to evaluate the health-related quality-of-life (HRQoL) improvement of patients undergoing laparoscopic versus open cholecystectomy. METHODS: A prospective observational study was performed of consecutive patients on waiting lists to undergo cholecystectomy for nonmalignant disease in six hospitals. Patients were asked to complete two questionnaires that measure (HRQoL)-the SF-36 and the Gastrointestinal Quality of Life Index (GIQLI)-before the intervention and 3 months later. RESULTS: Improvement after surgery, measured by the SF-36 and GIQLI, was similar for both surgical techniques. The SF-health transition item showed a perception of worse health, compared to 1 year previously, for those who underwent open surgery and complications were also higher. CONCLUSIONS: HRQoL improvement at 3 months was relevant and similar for both surgical techniques, although the health transition perception was worse for those who underwent open surgery. 相似文献
3.
Quintana JM Cabriada J Aróstegui I Oribe V Perdigo L Varona M Bilbao A 《Annals of surgery》2005,241(1):110-118
OBJECTIVE: To evaluate the relationship among appropriateness of the use of cholecystectomy and outcomes. SUMMARY BACKGROUND DATA: The use of cholecystectomy varies widely across regions and countries. Explicit appropriateness criteria may help identify suitable candidates for this commonly performed procedure. This study evaluates the relationship among appropriateness of the use of cholecystectomy and outcomes. METHODS: Prospective observational study in 6 public hospitals in Spain of all consecutive patients on waiting lists to undergo cholecystectomy for nonmalignant disease. Explicit appropriateness criteria for the use of cholecystectomy were developed by a panel of experts using the RAND appropriateness methodology and applied to recruited patients. Patients were asked to complete 2 questionnaires that measure health-related quality of life-the Short Form 36 (SF-36) and the Gastrointestinal Quality of Life Index (GIQLI)-before the intervention and 3 months after it. RESULTS: Patients judged as being appropriate candidates for cholecystectomy, using the panel's explicit appropriateness criteria, had greater improvements in the bodily pain, vitality, and social function domains of the SF-36 than those judged to be inappropriate candidates. They also demonstrated improvements in the GIQLI's physical impairment domain. Interventions judged as inappropriate were performed primarily among patients without symptoms of cholelithiasis. Those asymptomatic had a lower improvement in the bodily pain, social functioning, and physical summary scale of the SF-36 and in the symptomatology, physical impairment, and total score domains of the GIQLI. CONCLUSIONS: These results suggest a direct relationship between the application of explicit appropriateness criteria and better outcomes, as measured by health-related quality of life. They also indicate that patients without symptoms are not good candidates for cholecystectomy. 相似文献
4.
Hon-Yi Shi Hao-Hsien Lee Chong-Chi Chiu Herng-Chia Chiu Yih-Huei Uen King-Teh Lee 《Journal of gastrointestinal surgery》2008,12(7):1275-1282
Introduction To compare responsiveness and minimal clinically important differences (MCID) between the Gastrointestinal Quality of Life
(GIQLI) and the Short Form 36 (SF-36), we prospectively analyze 159 patients undergoing cholecystectomy at two tertiary academic
hospitals.
Patients and Methods All patients completed the disease-specific GIQLI and the generic SF-36 before and 3 months after surgery. Scores using these
instruments were interpreted by generalized estimating equation before and after cholecystectomy. The bootstrap estimation
was used to derive 95% confidence intervals for differences in the responsiveness estimates.
Results and Discussion Mean changes in all GIQLI and the SF-36 subscales were statistically significant (p < 0.05). Comparisons of effect size (ES), standardized response means (SRM), and relative efficiency (>1) indicated that
the responsiveness of the GIQLI was superior to that of the SF-36. In the equivalence test, all lower or upper confidence
limits presented no equivalence (>5), indicating good MCID. The ES and SRM for emotions and physical function in the GIQLI
significantly differed from those of the SF-36 (p < 0.05).
Conclusion The data in this study indicate that clinicians and health researchers should weight disease-specific measures more heavily
than generic measures when evaluating treatment outcomes. 相似文献
5.
Hon-Yi Shi King-Teh Lee Hao-Hsien Lee Yih-Huei Uen Jinn-Tsong Tsai Chong-Chi Chiu 《Journal of gastrointestinal surgery》2009,13(9):1651-1658
Purpose This study analyzed patient demographics and preoperative functional status for associations with post-cholecystectomy quality
of life (QOL).
Methods This prospective study analyzed 159 cholecystectomy patients at two tertiary academic hospitals. All patients completed the
SF-36 and the gastrointestinal quality of life index (GIQLI) at baseline and at 3 and 6 months postoperatively. The 95% confidence
intervals for differences in responsiveness estimates were derived by bootstrap estimation. Scores derived by these instruments
were interpreted by generalized estimating equation (GEE) before and after cholecystectomy.
Results The examined population significantly (p < 0.05) improved in both SF-36 subscales and GIQLI subscales. After adjusting for time effects (time, and time2) and baseline predictors, GEE approaches revealed the following explanatory variables for QOL: time, time2, age, gender, preoperative GIQLI score, body mass index, and number of comorbidities.
Conclusion The data revealed dramatically improved post-cholecystectomy QOL. However, QOL change was simultaneously associated with preoperative
functional status and demographic characteristics. 相似文献
6.
Quintana JM Aróstegui I Cabriada J López de Tejada I Perdigo L 《The British journal of surgery》2003,90(12):1549-1555
BACKGROUND: Few studies have assessed health-related quality of life (HRQoL) among patients undergoing cholecystectomy. This study aimed to determine clinical variables that predict changes in HRQoL following cholecystectomy. METHODS: This was a prospective study of consecutive patients undergoing elective cholecystectomy for gallstones in six hospitals. Patients were asked to complete two questionnaires-the Short Form 36 (SF-36) and the Gastrointestinal Quality of Life Index (GIQLI)-before and 3 months after cholecystectomy. Multivariate linear regression models were used to examine factors potentially contributing to changes in HRQoL. RESULTS: Patients with symptomatic cholelithiasis and low surgical risk experienced the highest HRQoL gains in several SF-36 and GIQLI domains, with significant improvements in physical function detected by both instruments, compared with asymptomatic individuals at high surgical risk. Patients with asymptomatic cholelithiasis or high surgical risk experienced least improvement. CONCLUSION: These data indicate that cholecystectomy is appropriate for patients with symptomatic cholelithiasis and low surgical risk. In terms of HRQoL, the risk to benefit ratio seems poor for patients with asymptomatic gallstones. 相似文献
7.
Scheingraber S Scheingraber T Brauckhoff M Dralle H 《Journal of Hepato-Biliary-Pancreatic Surgery》2005,12(4):290-297
Background/Purpose The aim of this study was to compare the short-form (SF-) 36 as a general instrument and the gastrointestinal quality of life index (GIQLI) as a disease-specific instrument in patients after pancreatic surgery.Methods The questionnaires were sent to patients receiving pancreatic surgery over a time period of three years. Patients were compared with a normal population completing the SF-36 or reported normal-population values for the GIQLI. Agreement between the instruments was analyzed using Bland Altman plots.Results A total of 98 patients were included, most of them undergoing a Whipple procedure (86%). The most frequent complaints were meteorism, obstipation, stool urgency, and stress incontinence in 9% of the patients. Whereas in almost every domain of the SF-36 the HRQL was impaired in comparison to the normal population, the GIQLI showed differences in only the domain emotions. Neither the SF-36 nor the GIQLI was different between patients with early and advanced cancer stages. The SF-36 had no agreement with the GIQLI.Conclusions The results of HRQL studies depend on the instruments which were used. Whereas a general instrument may detect factors such as comorbidity more accurately, disease-specific instruments have the advantage of better clinical interpretability.Presented at the 120th Congress of the German Society for Surgery, Munich, May 2003 相似文献
8.
Keus F Ahmed Ali U Noordergraaf GJ Roukema JA Gooszen HG van Laarhoven CJ 《Acta anaesthesiologica Scandinavica》2008,52(3):363-373
Background: Upper abdominal surgery, including laparoscopic cholecystectomy (LC), is associated with post-operative pulmonary dysfunction. LC has, by consensus, become the treatment of choice for symptomatic cholecystolithiasis. The small-incision cholecystectomy (SIC), a procedure which does not require a pneumoperitoneum threatens to be lost to clinical practice even though there is evidence of equality. We hypothesized that the SIC technique should be equal and might even be superior to the LC when considering post-operative pulmonary function due to the short incision length.
Methods: A single-centre, randomized clinical trial was performed including patients scheduled for elective cholecystectomy. Pulmonary flow–volume curves were measured pre-operatively, post-operatively, and at follow up. Blood gas analyses were measured pre-operative, in the recovery phase and on post-operative day 1. Anaesthesia, analgesics, and peri-operative care were standardized by protocol. Post-operatively, patients and caregivers were blinded to the procedure.
Results: A total of 257 patients were analysed. There was one pulmonary complication (pneumonia) in the LC group. In both groups, similar reductions of approximately 20% in pulmonary function parameters occurred, with complete recovery to pre-operative values. Patients in the SIC group consumed more analgesia when compared with the LC group without impact on blood gas analysis. Patients converted to a conventional open technique showed significant differences in six of the eight parameters in pulmonary function tests.
Conclusion: When evaluated with strict methodology and standardization of care, no clinically relevant differences were found between SIC and LC regarding pulmonary function. Our results suggest that the popularity of the laparoscopic technique cannot be attributed to pulmonary preservation. 相似文献
Methods: A single-centre, randomized clinical trial was performed including patients scheduled for elective cholecystectomy. Pulmonary flow–volume curves were measured pre-operatively, post-operatively, and at follow up. Blood gas analyses were measured pre-operative, in the recovery phase and on post-operative day 1. Anaesthesia, analgesics, and peri-operative care were standardized by protocol. Post-operatively, patients and caregivers were blinded to the procedure.
Results: A total of 257 patients were analysed. There was one pulmonary complication (pneumonia) in the LC group. In both groups, similar reductions of approximately 20% in pulmonary function parameters occurred, with complete recovery to pre-operative values. Patients in the SIC group consumed more analgesia when compared with the LC group without impact on blood gas analysis. Patients converted to a conventional open technique showed significant differences in six of the eight parameters in pulmonary function tests.
Conclusion: When evaluated with strict methodology and standardization of care, no clinically relevant differences were found between SIC and LC regarding pulmonary function. Our results suggest that the popularity of the laparoscopic technique cannot be attributed to pulmonary preservation. 相似文献
9.
Keus F Ahmed Ali U Noordergraaf GJ Roukema JA Gooszen HG van Laarhoven CJ 《Acta anaesthesiologica Scandinavica》2007,51(8):1068-1078
BACKGROUND: Upper abdominal surgery, including laparoscopic cholecystectomy (LC), is associated with post-operative pulmonary dysfunction. LC has, by consensus, become the treatment of choice for symptomatic cholecystolithiasis. Small-incision cholecystectomy (SIC), a procedure that does not require a pneumoperitoneum, threatens to be lost to clinical practice, even though there is evidence of equality. We hypothesized that the SIC technique should be equal, and might even be superior, to LC when considering post-operative pulmonary function because of the short incision length. METHODS: A single-centre randomized clinical trial was performed including patients scheduled for elective cholecystectomy. Pulmonary flow-volume curves were measured pre-operatively, post-operatively and at follow-up. Blood gas analyses were measured pre-operatively, in the recovery phase and on post-operative day 1. Anaesthesia, analgesics and peri-operative care were standardized by protocol. Post-operatively, patients and caregivers were blind to the procedure. RESULTS: Two hundred and fifty-seven patients were analysed. There was one pulmonary complication (pneumonia) in the LC group. In both groups, similar reductions of approximately 20% in pulmonary function parameters occurred, with complete recovery to pre-operative values. Patients in the SIC group consumed more analgesia when compared with the LC group, without any impact on blood gas analysis. Patients converted to a conventional open technique showed significant differences in six of the eight parameters in pulmonary function tests. CONCLUSION: When evaluated with strict methodology and standardization of care, no clinically relevant differences were found between SIC and LC with regard to pulmonary function. Our results suggest that the popularity of the laparoscopic technique cannot be attributed to pulmonary preservation. 相似文献
10.
Huber JF Satkauskas I Theiler R Zumstein M Ruflin GB 《Zeitschrift für Orthop?die und ihre Grenzgebiete》2006,144(3):296-300
AIM: The aim of this study was to determine the outcome after total hip replacement (THR) with the WOMAC and the SF-36 as well as to identify the most responsive items and to elucidate the reasons for increased pain postoperatively. METHODS: 73 patients filled out the questionnaires preoperatively and 3, 6, 12, 24 months postoperatively. All mean subscales and the responsiveness for each question were calculated. The patients with increased pain postoperatively were reassessed. RESULTS: All WOMAC subscales and six of the eight SF-36 subscales showed significant improvements after THR (p < 0.05). The most responsive items were the pain and disability questions (SRM, ES > 1.5). Two patients with a higher pain score postoperatively had associated symptomatic degenerative lumbar spinal disease. CONCLUSIONS: The WOMAC and the SF-36 are valid measures of the outcomes of THR in their German translations and document the good results after THR. Two years after THR the patients reach the same health state compared to an age matched control group in the population. The WOMAC contains more questions of higher responsiveness than the SF-36. A higher pain score postoperatively may be caused by degenerative disease of the lumbar spine. 相似文献
11.
BACKGROUND: Laparoscopic cholecystectomy (LC) is traditionally performed with two 10-mm and two 5-mm trocars. The effect of smaller port incisions on pain has not been established in controlled studies. METHODS: In a double-blind controlled study, patients were randomized to LC or cholecystectomy with three 2-mm trocars and one 10-mm trocar (micro-LC). All patients received a multimodal analgesic regimen, including incisional local anesthetics at the beginning of surgery, NSAID, and paracetamol. Pain was registered preoperatively, for the first 3 h postoperatively, and daily for the 1st week. RESULTS: The study was discontinued after inclusion of 26 patients because five of the 13 patients (38%) randomized to micro-LC were converted to LC. In the remaining 21 patients, overall pain and incisional pain intensity during the first 3 h postoperatively increased in the LC group (n = 13) compared with preoperative pain levels (p<0.01), whereas pain did not increase in the micro-LC group (n = 8). CONCLUSIONS: Micro-LC in combination with a prophylactic multimodal analgesic regimen reduced postoperative pain for the first 3 h postoperatively. However, the micro-LC led to an unacceptable rate of conversion to LC (38%). The micro-LC instruments therefore need further technical development before this surgical technique can be used on a routine basis for laparoscopic cholecystectomy. 相似文献
12.
Bremers AJ Ringers J Vijn A Janss RA Bemelman WA 《Journal of laparoendoscopic & advanced surgical techniques. Part A》2000,10(4):199-202
BACKGROUND AND PURPOSE: Postoperative adhesions frequently occur and can account for various symptoms, including chronic abdominal pain. Conventional adhesiolysis by laparotomy results in an unacceptably high rate of recurrence. A minimally invasive procedure (laparoscopic adhesiolysis) might improve the outcome by inflicting less surgical trauma, but well-documented reports focused on laparoscopic adhesiolysis for chronic abdominal pain are lacking. PATIENTS AND METHODS: Twelve consecutive patients with chronic abdominal pain caused by adhesions who were treated by laparoscopic adhesiolysis were assessed preoperatively and during a 1-year follow-up period applying validated scoring systems: McGill and SLC-90 tests to evaluate personalities and MOS SF-36 and GIQLI questionnaires for the quality of life assessments. RESULTS: No psychological influences were identified. Only two patients experienced a lasting improvement in quality of life, and five patients had more or less stable complaints. Five patients required laparotomy within a year after laparoscopic adhesiolysis. CONCLUSIONS: Laparoscopic adhesiolysis has yet not passed the stage of clinical trial and requires objective evaluation, including detailed information on recurrence and de novo adhesions in correlation with clinical outcome. 相似文献
13.
Yuki Kuroyama Mitsuru Tabusadani Shunya Omatsu Miyako Hiramatsu Yuji Shiraishi Hiroshi Kimura Hideaki Senjyu 《Annals of thoracic and cardiovascular surgery》2022,28(2):103
Purpose: To investigate the exercise capacity and health-related quality of life (HRQOL) of surgical patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) preoperatively versus 6 months postoperatively.Methods: This prospective observational study included patients with NTM-PD and was conducted at a single center. The intervention was surgical resection plus perioperative and post-discharge physical therapy. The physical function was assessed preoperatively and 6 months postoperatively using the 6-minute walk test (6MWT). HRQOL was assessed preoperatively and 6 months postoperatively using the Short-Form 36 (SF-36) health survey questionnaire and St. George’s Respiratory Questionnaire. The postoperative HRQOL was compared between patients with and without preoperative clinical symptoms.Results: In total, 35 patients were analyzed. The preoperatively symptomatic group had significantly lower preoperative HRQOL than the preoperatively asymptomatic group (p <0.05). Compared with preoperatively, there were significant improvements at 6 months postoperatively in the 6MWT (p <0.01) and HRQOL, mainly in the SF-36 mental component summary (p <0.01). The SF-36 mental component summary in the preoperatively symptomatic group was very significantly improved from preoperatively to 6 months postoperatively (p <0.05).Conclusion: The combination of surgical treatment and physical therapy for NTM-PD contributes to improvements in physical function and HRQOL. 相似文献
14.
Durkin M. T. Turton E. P. L. Wijesinghe L. D. Scott D. J. A Berridge D. C. 《European journal of vascular and endovascular surgery》2001,21(6):545-549
OBJECTIVES: To assess the quality of life of patients undergoing sapheno-femoral junction (SFJ) ligation and long saphenous vein stripping (LSV), using two different techniques. DESIGN: Prospective, randomised trial. MATERIALS AND METHODS: Eighty patients were recruited and randomised to either Perforate Invagination (PIN) stripping (43) or Conventional stripping (37). Patients completed the Short Form 36 (SF-36) and EuroQol (EQ) questionnaires preoperatively, and postoperatively at 6 weeks and 6 months. RESULTS: Bodily pain, role function and physical summary were significantly improved at 6 months in the PIN stripping group. In the Conventional group, bodily pain and physical function were similarly improved, but not role function. EQ global quality of life was significantly and progressively improved at 6 weeks and 6 months in the PIN group (global score p<0.003; self-rated score p <0.001). In the Conventional group there was no overall improvement in global score or self-rated health. CONCLUSIONS: Primary varicose vein surgery is associated with significant and progressive improvements in quality of life scores. Whilst overall quality of health does improve in the Conventional group, this appears to be to a lesser extent than in the PIN group. 相似文献
15.
Post-operative pain in needlescopic versus conventional laparoscopic cholecystectomy: a prospective randomised trial 总被引:4,自引:0,他引:4
Look M Chew SP Tan YC Liew SE Cheong DM Tan JC Wee SB Teh CH Low CH 《Journal of the Royal College of Surgeons of Edinburgh》2001,46(3):138-142
BACKGROUND: Needlescopic cholecystectomy (NC) utilises instruments and ports smaller than 3 mm in diameter compared with the 5 mm ones used in conventional laparoscopic cholecystectomy (LC). Post-operative pain control and recovery has been thought to be superior in NC, when compared with historical controls with LC, but has not been proven in a prospective fashion. PATIENTS AND METHODS: A prospective randomised trial of NC versus LC for patients with symptomatic gallstone disease, with standardisation of post-operative analgesia and daily assessment of post-operative pain, using a 5-point visual analogue scale. RESULTS: There were 64 eligible patients randomised into NC (28) and LC (36). Four patients who had NC were converted to LC due to technical problems. Another three and six patients from the NC and LC groups, respectively, had conversion to open surgery. Post-operative pain scores were low in both groups. Mean pain scores for those with successful NC and LC were: 1.24 versus 1.43 for the day of operation (P = 0.49), 0.86 versus 0.83 for the first day post-operatively (P = 0.92) and 0.75 versus 0.81 for the second post-operative day (P = 0.87). The mean number of intra-muscular analgesic injections required were 0.76 versus 0.83 after NC and LC, respectively (P = 0.93). There were no significant differences between the two groups in the time taken to return to feeding, eating a normal diet and discharge from hospital. CONCLUSION: There is no advantage of NC over LC in terms of post-operative pain or recovery. Nevertheless, NC can be performed safely and expediently and has an excellent cosmetic outcome and high patient acceptability. 相似文献
16.
Background The project aimed at testing the feasibility of a quality improvement system based on patient-reported outcomes in short-stay
surgery for cholecystectomy.
Methods In two centers for short-stay surgery, patients referred for laparoscopic cholecystectomy were surveyed between Aug 1999 and
Jan 2002. Patients reported on health-related quality of life (SF-36), symptoms (gallstone symptom checklist, GSCL) and other
indicators preoperatively (T0), 14 days (T1) and 6 months postoperatively (T2). The SF-36 subscales physical functioning,
bodily pain, and role physical as well as the GSCL and treatment satisfaction at T2 were considered as main outcomes. The
main outcomes were analyzed by generalized linear models with regard to predictors.
Results At T0 a total of 205 patients were included. The response rate at T2 was 63.4% (74.6% females, 53.6 years of age). The GSCL
score at T0 (29.4% preoperatively) fell slightly to 27.9% at T1 and decreased to 14.8% at T2 (T0–T2: p < 0.001). The SF-36 subscales showed a different course over time (decrease of health-related quality of life at T1 and large
increase at T2). The level of satisfaction with the outcome of cholecystectomy was 82.3%. The patient-reported outcomes were
mainly influenced by the preoperative level, age and self-reported postoperative complaints.
Conclusion The low response rate was mainly due to nondelivery of questionnaires at T1 during the regular postoperative visit by the
operating physician. Though nonresponse occurs under conditions of routine care, meaningful information was gained, which
should be used for quality improvement activities. Because the preoperative level is a major determinant of the postoperative
health outcomes, the prospective pre–post measurement should be preferred if institutional comparisons are intended. 相似文献
17.
腹腔镜技术在泌尿系和胆囊疾病中的联合应用 总被引:1,自引:0,他引:1
目的:探讨腹腔镜技术在泌尿系和胆囊疾病中联合应用的可行性及应用前景。方法:回顾性分析2001年10月~2004年6月间施行的腹腔镜联合手术28例,分别为腹腔镜胆囊切除术(LC)联合肾脏切除术4例,联合肾囊肿去顶减压术22例,联合肾上腺切除术2例。结果:1例右侧肾上腺结核病者因与下腔静脉粘连严重改行开放手术,其余联合手术均获成功。手术时间50~150min,平均110min;术中出血10~50ml,平均20ml;术后12~36h肛门排气,无并发症。术后住院4~6天,平均4,7天。结论:只要严格掌握联合手术指征,腹腔镜联合手术就能够安全、有效地同时处理泌尿系及胆囊共存疾病,具有良好的应用前景。 相似文献
18.
A total of 176 consecutive patients undergoing either total hip or total knee arthroplasty were given SF-36 surveys at 4 time intervals: preoperatively and at 3 months, 6 months, and 1 year postoperatively. Transformed SF-36 scores were compared at the preoperative and 1-year time intervals between several demographic variables, including age, gender, number of sides replaced (unilateral vs bilateral procedure), and type of joint replacement surgery (knee or hip). Joint replacement surgery seemed to correct various self-reported health status differences that appeared preoperatively in demographic groups. 相似文献
19.
Sarmiento JM Farnell MB Nagorney DM Hodge DO Harrington JR 《Archives of surgery (Chicago, Ill. : 1960)》2004,139(5):483-8; discussion 488-9
HYPOTHESIS: Quality of life of patients after biliary reconstruction for laparoscopic injuries is comparable to that of patients after laparoscopic cholecystectomy. DESIGN: Outcomes study. SETTING: Tertiary referral center. PATIENTS: Records of 59 consecutive patients undergoing surgical reconstruction of the biliary tract after injury induced by laparoscopic cholecystectomy between 1990 and 1997 were reviewed. Hepp-Couinaud technique or Roux-en-Y hepaticojejunostomy was used in 53 patients; other procedures included cholangiojejunostomy, choledochorrhaphy, and hepaticoduodenostomy. INTERVENTIONS: Quality-of-life questionnaires (36-Item Short-Form Health Survey [SF-36]) were mailed to each patient in the group and to patients who underwent uneventful laparoscopic cholecystectomy, matched individually by year, sex, and age group. Values from the general population matched by age and sex were gathered (national norms). Minimum time of follow-up was 5 years. RESULTS: Eighty-nine (81%) of 110 potential respondents to the survey completed the SF-36 questionnaires. All 8 values evaluated in the SF-36 questionnaire (physical functioning, role-physical, bodily pain, general health perceptions, vitality, social functioning, role-emotional, and mental health index) for patients undergoing biliary reconstruction were similar to those of both their matched controls (all P >.10) and national norms (all P >.05). The standardized physical component scale was also similar between the 2 groups (cases vs controls, 51 vs 48; P =.47), as was the standardized mental component scale (cases vs controls, 55 vs 55; P =.60). CONCLUSIONS: With a minimum of 5 years of follow-up, the quality of life after surgical biliary reconstruction compares favorably with that of both patients undergoing uneventful laparoscopic cholecystectomy and national norms. 相似文献
20.