Demircan Orhan, Baymus Mustafa, Seydaoglu Gülsah, Akinoglu Alper, Sakman Gürhan
Department of General Surgery, School of Medicine, University of Cukurova, Adana, Turkey.
Can J Surg. 2006 Jun;49(3):177-84.
Occult cystobiliary communication (CBC) presents with biliary leakage, if the cystobiliary opening cannot be detected and repaired at operation. We investigated the clinical signs associated with the risk of occult CBC in the preoperative period by studying patients who developed biliary leakage after hydatid liver surgery.
We analyzed the records of 191 patients treated for hydatid liver cyst. Postoperative biliary leakage developed in 41 patients (21.5%). Independent predictive factors were established by logistic regression analysis using clinical parameters, whose cutoff values were determined by receiver operating characteristic (ROC) curves.
Postoperative biliary leakage presented as external biliary fistula in 31 (75.6%) of 41 patients, as biliary peritonitis in 6 (14.6%) and as cyst cavity biliary abscess in 4 (9.8%). Independent clinical predictors of occult CBC, represented by biliary leakage, were alkaline phosphatase > 250 U/L, total bilirubin > 17.1 micromol/L, direct bilirubin > 6.8 micromol/L, gamma-glutamyl transferase > 34.5 U/L, eosinophils > 0.09 and cyst diameter > 8.5 cm. Multilocular or degenerate cysts increased the risk of biliary leakage (p = 0.012). Postoperative complication rates were 53.7% in the patients with biliary leakage, and 10.0% (p < 0.001) in those without. The mean postoperative hospital stay was longer in patients with biliary leakage (14.3 [and standard deviation {SD} 1.9] d) than in those without (7.3 [SD 2.3] d) (p < 0.001). Nineteen (61.3%) of 31 biliary fistulae closed spontaneously within 10 days. The remaining 12 (38.7%) fistulae closed within 7 days after endoscopic sphincterotomy.
Factors that predict occult CBC due to hydatid liver cyst were identified. These factors should allow the likelihood of CBC to be determined and, thus, indicate the need for additional procedures during operation to prevent the complications of biliary leakage.
隐匿性胆囊胆管瘘（CBC）如果在手术中无法检测到并修复胆囊胆管开口，就会出现胆漏。我们通过研究肝包虫手术后发生胆漏的患者，调查了术前与隐匿性CBC风险相关的临床体征。
我们分析了191例接受肝包虫囊肿治疗患者的记录。41例患者（21.5%）发生了术后胆漏。通过使用临床参数的逻辑回归分析确定独立预测因素，其临界值由受试者工作特征（ROC）曲线确定。
41例患者中，31例（75.6%）术后胆漏表现为外胆瘘，6例（14.6%）表现为胆汁性腹膜炎，4例（9.8%）表现为囊腔胆脓肿。以胆漏为代表的隐匿性CBC的独立临床预测因素为碱性磷酸酶>250 U/L、总胆红素>17.1 μmol/L、直接胆红素>6.8 μmol/L、γ-谷氨酰转移酶>34.5 U/L、嗜酸性粒细胞>0.09和囊肿直径>8.5 cm。多房性或退化性囊肿增加了胆漏风险（p = 0.012）。胆漏患者的术后并发症发生率为53.7%，无胆漏患者为10.0%（p < 0.001）。胆漏患者的术后平均住院时间（14.3 [标准差{SD} 1.9]天）比无胆漏患者（7.3 [SD 2.3]天）长（p < 0.001）。31例胆瘘中有19例（61.3%）在10天内自行闭合。其余12例（38.7%）瘘在内镜括约肌切开术后7天内闭合。
确定了预测肝包虫囊肿所致隐匿性CBC的因素。这些因素应能确定CBC的可能性，从而表明手术期间需要进行额外的操作以预防胆漏并发症。
