The comparison between endoscopic and surgical treatment of delayed iatrogenic bile duct injury by propensity score matching
10.3760/cma.j.cn112139-20230119-00033
- VernacularTitle:内镜和外科手术治疗迟发性医源性胆管损伤效果的倾向性评分匹配研究
- Author:
Hengtong HAN
1
;
Ping YUE
;
Wenbo MENG
;
Lei ZHANG
;
Kexiang ZHU
;
Xiaoliang ZHU
;
Long MIAO
;
Zhengfeng WANG
;
Haiping WANG
;
Xun LI
Author Information
1. 兰州大学第一临床医学院 兰州大学第一医院普通外科、外科内镜中心 甘肃省肝胆胰外科研究所 甘肃省生物治疗与再生医学重点实验室，兰州730030
- Keywords:
Surgical procedures, operative;
Intraoperative complications;
Delayed;
Iatrogenic;
Bile duct injury;
Endoscopic retrograde cholangiopancreatography;
Choledo
- From:
Chinese Journal of Surgery
2023;61(10):871-879
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the safety and clinical efficacy of endoscopic and surgical treatment of patients with delayed iatrogenic bile duct injury (DBDI) with severity (SG) grade 1 to 2.Methods:The clinical data of 129 patients with SG grade 1 to 2 DBDI who received endoscopic or surgical treatment in the First Hospital of Lanzhou University from November 2007 to November 2021 were retrospectively collected. There were 46 males and 83 females,aged ( M(IQR)) 54(22)years(range: 21 to 82 years). The baseline data of the two groups were matched 1∶1 by propensity score matching(caliper value was 0.2). Independent sample t test,rank sum test, χ2 test or Fisher exact probability test were used to analyze the data of the two matched groups. Results:There were 48 patients in each of the endoscopic treatment and surgical groups after matching,and there was no difference in general information between the two groups(both P>0.05). The bile duct injury-repair interval and intraoperative anesthesia complications were not statistically significant between the two groups after matching(all P>0.05). Compared with the surgical group, patients in the endoscopic treatment group had significantly shorter operative time(50 (30) minutes vs. 185 (100) minutes, Z=7.675, P<0.01) and postoperative hospital stay(5 (5) days vs. 12 (7) days, Z=5.848, P<0.01).For safety,there was no statistical difference in the incidence of immediate postoperative complications between the two groups with Clavien-Dindo classification of surgical complications<Ⅲ;the incidence of serious postoperative complications (Clavien-Dindo classification of surgical complications≥Ⅲ) was significantly higher in the surgical group than in the endoscopic treatment group( P=0.012). The incidence of long-term postoperative complications was not statistically different between the two groups(28.1% vs. 20.7%, P=0.562). In terms of efficacy,the postoperative liver function indexes of patients in both groups improved significantly compared with the preoperative period and returned to normal or near normal levels; the postoperative infection indexes of both groups showed an increasing trend,but were within the normal range. Of the 96 patients in both groups,61 obtained follow-up,and the follow-up time was (89.4±48.0)months(range: 3 to 165 months),and there was no statistical difference between the two groups( P=0.079). The probability of excellent long-term follow-up (78.1% vs. 86.2%) was not statistically different between the two groups( P=0.412).In patients with Strasberg-Bismuth type E1,the probability of excellent long-term follow-up was higher in the endoscopic treatment group compared with the surgical group(13/14 vs. 2/5, P=0.037). Conclusions:For DBDI patients with SG grade 1 to 2 and bile duct continuity,endoscopy can be used as the first deterministic treatment. The advantages of endoscopic therapy compared to surgery are the lower incidence of postoperative serious complications,and the shorter duration of surgery and postoperative hospital stay.
