Hepatobiliary Centre, Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris (AH-HP), Paris, France.
HPB (Oxford). 2009 Jun;11(4):364-9. doi: 10.1111/j.1477-2574.2009.00062.x.
Postoperative bile leak secondary to a fistula is a known complication of hepatic surgery. Four different biliary fistula sub-types have been described: type A refers to minor leakage from the bile duct stump; type B to major leakage caused by insufficient closure of the bile duct stump; type C to major leakage caused by injury to the bile duct, and type D (the rarest) to the division and exclusion of a bile duct. This complication results from functional liver parenchyma in which bile drainage is excluded from the main duct.
A retrospective review of the database for 163 patients diagnosed with post-hepatic surgery bile leak from April 1992 to June 2007 was performed.
Three patients were found to have type D biliary fistula, with durations of 3-21 months. The bile leak developed after a right hepatectomy in two patients and a right hepatectomy extending to segment IV in one patient. All three patients were rescheduled for surgical exploration, following failure of medical treatment. The procedure consisted of repeat resection of the independent liver parenchyma containing the fistula. One patient developed a postoperative leak from a hepaticojejunal anastomosis (treated conservatively) and the other two patients had an uneventful recovery. No recurrence of bile leak was encountered during their follow-up.
Our experience indicates that conservative treatment is deceptive and not efficacious. For this condition, surgical intervention is the treatment of choice because it is very effective and is associated with a low morbidity.
术后胆漏继发于瘘管是肝外科手术的已知并发症。已经描述了四种不同的胆瘘亚型：A 型指胆管残端的少量漏液；B 型指胆管残端闭合不足导致的大量漏液；C 型指胆管损伤导致的大量漏液；D 型（最罕见）指胆管的分割和排除。这种并发症是由功能正常的肝实质引起的，其中胆汁引流被排除在主胆管之外。
对 1992 年 4 月至 2007 年 6 月期间诊断为肝术后胆漏的 163 例患者的数据库进行回顾性分析。
发现 3 例患者为 D 型胆瘘，持续时间为 3-21 个月。2 例患者在右肝切除术后和 1 例患者在右肝切除延伸至 IV 段后出现胆漏。所有 3 例患者均在药物治疗失败后进行手术探查。手术包括重复切除包含瘘管的独立肝实质。1 例患者术后出现胆肠吻合口漏（保守治疗），另外 2 例患者恢复顺利。在随访期间未发现胆漏复发。
我们的经验表明，保守治疗是不可靠的，也没有效果。对于这种情况，手术干预是首选治疗方法，因为它非常有效，且发病率低。
