PDF(Pubmed)
Abstract：
Postoperative bile leakage (POBL) is one of the most common complications after liver resection. However, current studies on the risk factors for POBL and their impacts on surgical outcomes need to be more consistent. This study aims to conduct a meta-analysis to analyze the risk factors for POBL after hepatectomy.
We incorporated all eligible studies from Embase, PubMed, and the Web of Science database (until July 2022) into this study. RevMan and STATA software were used to analyze the extracted data.
A total of 39 studies, including 43,824 patients, were included in this meta-analysis. We found that gender, partial hepatectomy, repeat of hepatectomy, extended hepatectomy, abdominal drain, diabetes, Child≥B, solitary tumor, and chemotherapy are the factors of grade B and C POBL. Some recognized risk factors were considered potential risk factors for grade B and C bile leakage because no subgroup analysis was performed, like HCC, cholangiocarcinoma, major resection, posterior sectionectomy, bi-segmentectomy, S4 involved, S8 involved, central hepatectomy, and bile duct resection/reconstruction. Meanwhile, cirrhosis, benign diseases, left hepatectomy, and Segment 1 resection were not significant for grade B and C bile leakage. The influence of lateral sectionectomy, anterior sectionectomy, S1 involved, S3 involved, high-risk procedure, laparoscope, and blood loss>1000 mL on POBL of ISGLS needs further research. Meanwhile, POBL significantly influenced overall survival (OS) after liver resection.
We identified several risk factors for POBL after hepatectomy, which could prompt the clinician to decrease POBL rates and make more beneficial decisions for patients who underwent the hepatectomy.
We incorporated all eligible studies from Embase, PubMed, and the Web of Science database (until July 2022) into this study. RevMan and STATA software were used to analyze the extracted data.
A total of 39 studies, including 43,824 patients, were included in this meta-analysis. We found that gender, partial hepatectomy, repeat of hepatectomy, extended hepatectomy, abdominal drain, diabetes, Child≥B, solitary tumor, and chemotherapy are the factors of grade B and C POBL. Some recognized risk factors were considered potential risk factors for grade B and C bile leakage because no subgroup analysis was performed, like HCC, cholangiocarcinoma, major resection, posterior sectionectomy, bi-segmentectomy, S4 involved, S8 involved, central hepatectomy, and bile duct resection/reconstruction. Meanwhile, cirrhosis, benign diseases, left hepatectomy, and Segment 1 resection were not significant for grade B and C bile leakage. The influence of lateral sectionectomy, anterior sectionectomy, S1 involved, S3 involved, high-risk procedure, laparoscope, and blood loss>1000 mL on POBL of ISGLS needs further research. Meanwhile, POBL significantly influenced overall survival (OS) after liver resection.
We identified several risk factors for POBL after hepatectomy, which could prompt the clinician to decrease POBL rates and make more beneficial decisions for patients who underwent the hepatectomy.
摘要：
目的：术后胆漏是肝切除术后最常见的并发症之一。然而,目前关于POBL危险因素及其对手术结局影响的研究需要更加一致.本研究旨在进行Meta分析,分析肝切除术后POBL的危险因素。
方法：我们纳入了Embase的所有符合条件的研究，PubMed,和WebofScience数据库（直到2022年7月）进入这项研究。采用RevMan和STATA软件对提取的数据进行分析。
结果：共39项研究，包括43,824名病人,纳入本荟萃分析。我们发现性别,肝部分切除术,重复肝切除术，扩大肝切除术,腹腔引流,糖尿病,儿童≥B，孤立性肿瘤，和化疗是B级和C级POBL的因素。一些公认的危险因素被认为是B级和C级胆漏的潜在危险因素，因为没有进行亚组分析。像肝癌一样，胆管癌,大切除,后路切除术,双段切除术,涉及S4，涉及S8，中央肝切除术,和胆管切除/重建。同时,肝硬化,良性疾病,左肝切除术,1段切除对B级和C级胆漏无统计学意义。侧切术的影响，前路切除术,涉及S1，涉及S3，高风险手术，腹腔镜,ISGLS的POBL失血量>1000mL需要进一步研究。同时,POBL显著影响肝切除术后的总生存期（OS）。
结论：我们确定了肝切除术后POBL的几个危险因素，这可能会促使临床医生降低POBL率，并为接受肝切除术的患者做出更有益的决定。
方法：我们纳入了Embase的所有符合条件的研究，PubMed,和WebofScience数据库（直到2022年7月）进入这项研究。采用RevMan和STATA软件对提取的数据进行分析。
结果：共39项研究，包括43,824名病人,纳入本荟萃分析。我们发现性别,肝部分切除术,重复肝切除术，扩大肝切除术,腹腔引流,糖尿病,儿童≥B，孤立性肿瘤，和化疗是B级和C级POBL的因素。一些公认的危险因素被认为是B级和C级胆漏的潜在危险因素，因为没有进行亚组分析。像肝癌一样，胆管癌,大切除,后路切除术,双段切除术,涉及S4，涉及S8，中央肝切除术,和胆管切除/重建。同时,肝硬化,良性疾病,左肝切除术,1段切除对B级和C级胆漏无统计学意义。侧切术的影响，前路切除术,涉及S1，涉及S3，高风险手术，腹腔镜,ISGLS的POBL失血量>1000mL需要进一步研究。同时,POBL显著影响肝切除术后的总生存期（OS）。
结论：我们确定了肝切除术后POBL的几个危险因素，这可能会促使临床医生降低POBL率，并为接受肝切除术的患者做出更有益的决定。
