背景:胆漏是开腹肝切除术治疗胆道癌的常见且严重的并发症。
目的:为了评估发病率,危险因素,胆道癌患者开腹肝切除术后胆漏的处理。
方法:我们回顾性分析了2018年2月至2023年2月因胆道癌接受开放式肝切除术的120例患者。胆漏定义为手术部位或引流管的胆汁引流或影像学上存在胆汁瘤。发病率,严重程度,定时,location,并记录胆漏的治疗情况。采用单因素和多因素logistic回归分析胆漏的危险因素。
结果:胆漏发生率为16.7%(20/120),大多数病例为A级(75%,15/20)根据国际肝脏外科研究小组的分类。中位发病时间为5d(范围,1-14d),中位持续时间为7d(范围,2-28天)。胆漏最常见的位置是肝脏的切面(70%,14/20),其次是吻合部位(25%,5/20)和胆囊管残端(5%,1/20)。大多数胆漏采用保守引流治疗,抗生素,和营养支持(85%,17/20),而有些需要内镜逆行胰胆管造影术和支架置入术(10%,2/20)或经皮肝穿刺胆管造影引流(5%,1/20)。胆漏的危险因素包括男性,肝细胞癌,肝脏大切除术,失血,和输血。
结论:胆漏是开腹肝切除术治疗胆道癌的常见并发症。然而,大多数病例是轻度的,可以保守治疗。男性,肝细胞癌,肝脏大切除术,失血,输血与胆漏风险增加相关.
BACKGROUND: Bile leakage is a common and serious complication of open hepatectomy for the treatment of biliary tract cancer.
OBJECTIVE: To evaluate the incidence, risk factors, and management of bile leakage after open hepatectomy in patients with biliary tract cancer.
METHODS: We retrospectively analyzed 120 patients who underwent open hepatectomy for biliary tract cancer from February 2018 to February 2023. Bile leak was defined as bile drainage from the surgical site or drain or the presence of a biloma on imaging. The incidence, severity, timing, location, and treatment of the bile leaks were recorded. The risk factors for bile leakage were analyzed using univariate and multivariate logistic regression analyses.
RESULTS: The incidence of bile leak was 16.7% (20/120), and most cases were grade A (75%, 15/20) according to the International Study Group of Liver Surgery classification. The median time of onset was 5 d (range, 1-14 d), and the median duration was 7 d (range, 2-28 d). The most common location of bile leakage was the cut surface of the liver (70%, 14/20), followed by the anastomosis site (25%, 5/20) and the cystic duct stump (5%, 1/20). Most bile leaks were treated conservatively with drainage, antibiotics, and nutritional support (85%, 17/20), whereas some required endoscopic retrograde cholangiopancreatography with stenting (10%, 2/20) or percutaneous transhepatic cholangiography with drainage (5%, 1/20). Risk factors for bile leakage include male sex, hepatocellular carcinoma, major hepatectomy, blood loss, and blood transfusion.
CONCLUSIONS: Bile leakage is a frequent complication of open hepatectomy for biliary tract cancer. However, most cases are mild and can be conservatively managed. Male sex, hepatocellular carcinoma, major hepatectomy, blood loss, and blood transfusion were associated with an increased risk of bile leak.