Abstract：
Although bile leakage is a major postoperative complication after hepatobiliary surgery, the associated risk factors for pediatric patients remain poorly defined. Here, we intend to identify the perioperative risk factors for bile leakage in pediatric patients with choledochal cysts following Roux-en-Y hepaticojejunostomy. A multicenter case-control study investigating the risk factors for bile leakage was conducted among 1179 eligible pediatric patients with choledochal cysts following Roux-en-Y hepaticojejunostomy between January 2009 and December 2019. There were 267 cases with bile leakage, and approximately four control patients were identified for each case. Multivariable logistic regression was performed to identify the risk factors, including perioperative variables. According to univariable analysis, bile leakage was associated with severe cholangitis (p = 0.012), low albumin levels (p = 0.010), anemia (p = 0.002) and laparoscopic surgery (p = 0.004). Multivariable analysis showed that a low level of preoperative albumin (ALB) (odds ratio [OR] = 1.11; 95% CI 1.02-1.19; p = 0.016), worse symptoms (severe cholangitis) (OR = 1.16; 95% CI 1.01-1.26; p < 0.001), and a previous hepatobiliary procedure (OR = 1.32; 95% CI 1.09-1.63; p = 0.036) were independent factors that were associated with bile leakage. This study identified potential risk factors for bile leakage in patients following Roux-en-Y hepaticojejunostomy that should be targeted for interventions to reduce the occurrence of the condition.
摘要：
尽管胆漏是肝胆手术后的主要并发症，儿科患者的相关危险因素仍未明确.这里,我们打算确定Roux-en-Y型肝管空肠吻合术后胆总管囊肿患儿发生胆漏的围手术期危险因素.2009年1月至2019年12月，在Roux-en-Y肝管空肠吻合术后，对1179例符合胆总管囊肿患儿进行了一项多中心病例对照研究，调查胆漏的危险因素。胆漏267例,每个病例约有4名对照患者。进行多变量logistic回归以确定危险因素，包括围手术期变量。根据单变量分析，胆漏与严重胆管炎相关（p=0.012），白蛋白水平低（p=0.010），贫血（p=0.002）和腹腔镜手术（p=0.004）。多变量分析显示术前白蛋白(ALB)水平较低(比值比[OR]=1.11;95%CI1.02-1.19;p=0.016),症状加重（严重胆管炎）（OR=1.16;95％CI1.01-1.26;p<0.001），和以前的肝胆手术（OR=1.32;95％CI1.09-1.63;p=0.036）是与胆漏相关的独立因素。这项研究确定了Roux-en-Y肝空肠吻合术后患者胆漏的潜在危险因素，应作为干预措施的目标，以减少这种情况的发生。
