Eurich Dennis, Henze S, Boas-Knoop S, Pratschke J, Seehofer D
Department of General, Visceral and Transplant Surgery, Charité Campus Virchow, Augustenburger Platz 1, 13353, Berlin, Germany.
Department of General, Visceral, Vascular and Thoracic Surgery, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany.
Updates Surg. 2016 Dec;68(4):369-376. doi: 10.1007/s13304-016-0397-5. Epub 2016 Sep 27.
Biliary leakage is a serious complication after liver resection and represents the major cause of post-operative morbidity. In spite of already identified risk factors, little is known about the role of intra-biliary pressure following liver surgery in the development of biliary leakage. Biliary decompression may have a positive impact and reduce the incidence of biliary leakage at the parenchymal resection site. 397 patients undergoing liver resection without bilioenteric anastomosis were included in the retrospective analysis of the risk factors for the development of biliary leakage focusing on the intra-operative reduction of the biliary pressure by T-tube and liver histology. Among 397 analyzed patients after parenchymal resection, biliary leakage occurred in 39 cases (9.8 %). The extent of parenchymal resection was not associated with the total occurrence of biliary leak (p = 0.626). Lower incidence of biliary leakage from the resection surface was significantly associated with the use of T-tube (4.9 vs. 13.2 %; p = 0.006). In the subgroup analysis, insertion of a T-tube was not associated with a reduction of biliary leakage after anatomical hemihepatectomies (p = 0.103) and extraanatomical liver resection (p = 0.676). However, a high statistical significance could be detected in patients with extended hemihepatectomies (58.3 vs. 3.8 %; p < 0.001). Once biliary leak occurred without T-tube, median hospitalization duration significantly increased compared to patients with biliary decompression and without biliary leak (p < 0.001). The results of our retrospective data analysis suggest a significant beneficial impact of the T-tube on the development of biliary leakage in patients undergoing extended liver surgery.
胆漏是肝切除术后的一种严重并发症，是术后发病的主要原因。尽管已经确定了危险因素，但关于肝切除术后胆管内压力在胆漏发生中的作用知之甚少。胆管减压可能会产生积极影响，并降低实质切除部位胆漏的发生率。对397例行肝切除且未行胆肠吻合术的患者进行回顾性分析，重点关注通过T管降低术中胆管压力及肝脏组织学情况，以探讨胆漏发生的危险因素。在397例接受实质切除的分析患者中，有39例（9.8%）发生了胆漏。实质切除范围与胆漏的总体发生率无关（p = 0.626）。切除面胆漏发生率较低与使用T管显著相关（4.9% 对13.2%；p = 0.006）。在亚组分析中，解剖性半肝切除术后（p = 0.103）和非解剖性肝切除术后（p = 0.676），插入T管与胆漏减少无关。然而，在扩大半肝切除患者中可检测到高度统计学意义（58.3% 对3.8%；p < 0.001）。一旦未使用T管发生胆漏，与接受胆管减压且未发生胆漏的患者相比，中位住院时间显著延长（p < 0.001）。我们回顾性数据分析的结果表明，T管对接受扩大肝手术患者的胆漏发生有显著的有益影响。
