The long-term health-related quality of life of choledochal cyst patients who reach 18 years of age or older -Complications would affect mental health-
The long-term health-related quality of life of choledochal cyst patients who reach 18 years of age or older -Complications would affect mental health-
复制标题
年满18岁的胆总管囊肿患者的长期健康相关生活质量 -并发症会影响心理健康-
DOI：
10.1007/s00383-019-04498-x
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发表时间：
2019
影响因子：
1.8
通讯作者：
Ieiri S
中科院分区：
文献类型：
--
作者：
Baba T;Mukai M;Masuya R;Kawano M;Yano K;Onishi S;Yamada K;Yamada W;Kawano T; Machigashira S;Nakame K;Kaji T;Ieiri S
Baba等人[1]他们试图调查胆总管囊肿（CC）手术后患者的长期健康相关生活质量，值得赞扬。他们的论文有局限性，特别是44%的回复率，这可能会使数据偏向并发症患者。作者的调查问卷没有特别询问对腹部瘢痕的长期看法，但研究表明，CC切除术后不良的长期生活质量结局与手术并发症有关。健康相关的生活质量评分后，简单的手术CC是类似的正常人。本文强调了避免CC手术后长期并发症的重要性。在过去的15年中，关于儿科CC的大部分出版物都涉及腹腔镜胆总管囊肿切除术。腹腔镜切除术后的长期结果知之甚少，因为很少有文献记录术后随访时间超过5年。这是一个令人担忧的问题，原因有几个[2]。在大多数腹腔镜“根治性囊肿切除术”的报告中，胆肠吻合是近端肝总管，而不是宽肝门肝管空肠吻合[3]。这增加了晚期吻合口狭窄的风险[4]，并且不可避免地增加了残留胆管恶性肿瘤的小的长期风险。一些作者在相对较短的随访期内报告了腹腔镜CC切除术后胆肠狭窄和再次手术的高发生率[5-8]。肝总管吻合术也可能忽略肝门管狭窄[9]或异常的右肝动脉穿过肝总管前方，这是一种公认的解剖变异，在开放手术中很容易处理，但如果留下，可能会导致胆道梗阻[7]。CC切除后手术的长期结果被腹腔镜技术的技术挑战和潜在的短期收益所掩盖。我们不应该放弃腹腔镜技术，但需要将其推进到患者结局与专家开放手术相似的程度，即创建胆漏、粘连梗阻和晚期狭窄发生率极低的宽肝门肝空肠吻合术[2]，同时利用微创手术减少的术后疼痛和改善的美容效果。最重要的是，这是CC囊肿切除术的长期结果，决定了患者的成功，如Baba等人所强调的。[1]的文件。这些患者的寿命还很长（远远超出儿科外科医生的护理范围），我们有责任确保尽可能降低长期并发症。
Baba et al.[1] are to be commended on their attempt to investigate long-term health-related quality of life in patients after surgery for choledochal cyst (CC). Their paper has limitations, in particular the response rate of 44%, which may skew the data towards those with complications. The authors’ questionnaire did not specifically enquire about long-term perceptions of abdominal scarring, but the study demonstrated that adverse long-term quality-of-life outcomes after CC excision related to surgical complications. Health-related quality-of-life scores after uncomplicated surgery for CC were similar to those of normal individuals. The paper underlines the importance of avoiding long-term complications after CC surgery. A large proportion of publications on paediatric CC in the last 15 years have concerned laparoscopic choledochal cyst excision. Relatively little is known about the long-term outcomes after laparoscopic excision, since few publications have recorded postoperative follow-up periods beyond 5 years. This is a concern for several reasons [2]. In most reports of laparoscopic “radical cyst excision”, the bilioenteric anastomosis is to the proximal common hepatic duct rather than a wide hilar hepatico-jejunostomy [3]. This increases the risk of a late anastomotic stricture [4] and inevitably must increase the small long-term risk of residual bile duct malignancy. High rates of bilioenteric stricture and redo surgery after laparoscopic CC excision have been reported by some authors within relatively short follow-up periods [5–8]. Anastomosis to the common hepatic duct may also overlook a hilar duct stricture [9] or an aberrant right hepatic artery crossing anterior to the common hepatic duct, a well-recognized anatomical variant that is easily dealt with at open surgery but which can cause biliary obstruction if left [7].Currently, the long-term outcomes of surgery after CC excision are being overshadowed by the technical challenges and potential short-term gains of laparoscopic techniques. We should not abandon laparoscopic techniques, but they need to be advanced to the point that patient outcomes are similar to those achievable with expert open surgery, ie, creating a wide hilar hepatico-jejunostomy with very low rates of bile leak, adhesion obstruction, and late stricture [2], whilst taking advantage of the reduced postoperative pain and improved cosmesis of minimally invasive surgery. Crucially, it is the long-term outcome of CC cyst excision that determines success for the patient as highlighted by Baba et al.[1]. These patients have a lifetime ahead of them (well beyond the care of paediatric surgeons) and it is our duty to ensure that long-term complications are as low as possible.