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术中胆管造影(IOC)和亚甲蓝试验在降低活体供肝切除术后胆漏中的作用。

The role of Intraoperative cholangiography (IOC) and methylene blue tests in reducing bile leakage after living donor hepatectomy.

机构信息

Departman of Hepatopancreatobiliary Surgery, Şişli Etfal Hamidiye Training and Research Hospital, İstanbul, Turkey.

Departman of Transplant Surgery, Faculty of Medicine, Acıbadem Unıversity, İstanbul, Turkey.

出版信息

Asian J Surg. 2021 Jan;44(1):147-152. doi: 10.1016/j.asjsur.2020.04.001. Epub 2020 Aug 14.

Abstract

AIM

Liver transplantation remains the only curative treatment in end stage liver disease. Biliary complications remain the most common major morbidity causes in hepatic resection. We aimed to determine and eliminate the bile leakage in donor hepatectomy of LDLT.

MATERIAL AND METHODS

This study was conducted retrospective and one center study. The study population included 110 consequential liver donors with major liver resection (more than three segments). The population was divided into three groups for data analyses. Primary study groups included 40 donors subjected to methylene blue test starting in April 2013 and 40 donors subjected to intraoperative cholangiography started in March 2014.

RESULTS

A total of 110 liver donors (42.7% women) were included in the study. Postoperative biliary complications were less in methylene blue and intraoperative cholangiography (IOC) groups. Bile leakage was significantly higher in control group (23.3%) compared to methylene blue (5%) and IOC groups (2%) Average duration of hospital stay and duration of operation were significantly higher in control group compared to methylene blue and IOC groups.

CONCLUSION

In our study we conducted to establish biliary leakage in living donor hepatectomy which intraoperative cholangiography test was used to determine. Many intraoperative methods have been introduced to prevent biliary leakage and development of complications. We have showed that IOC test used in the present study could be easily applied in both living liver donor hepatectomy and other major hepatectomy cases. IOC test reduced postoperative biliary leakage incidence and did not increase incidence of other complications.

摘要

目的

肝移植仍然是治疗终末期肝病的唯一方法。胆道并发症仍然是肝切除术后最常见的主要并发症。我们旨在确定并消除 LDLT 供肝切除术中的胆漏。

材料和方法

本研究为回顾性和单中心研究。研究人群包括 110 例接受肝大部切除术(超过三个节段)的连续肝供者。人群分为三组进行数据分析。主要研究组包括 40 例从 2013 年 4 月开始接受亚甲蓝试验的供者和 40 例从 2014 年 3 月开始接受术中胆管造影的供者。

结果

共纳入 110 例肝供者(42.7%为女性)。亚甲蓝组和术中胆管造影组术后胆道并发症较少。对照组(23.3%)胆漏明显高于亚甲蓝组(5%)和术中胆管造影组(2%)。对照组的住院时间和手术时间均明显长于亚甲蓝组和术中胆管造影组。

结论

在本研究中,我们通过使用术中胆管造影试验来确定活体供肝切除术中的胆漏。已经引入了许多术中方法来预防胆漏和并发症的发生。我们表明,本研究中使用的术中胆管造影试验可以很容易地应用于活体肝供肝切除术和其他肝切除术。术中胆管造影试验降低了术后胆漏的发生率,且未增加其他并发症的发生率。

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