Department of Pediatric Surgery, Saitama Medical University, 38 Morohongo, Moroyama, Iruma-gun, Saitama, 350-0495, Japan.
Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan.
Pediatr Surg Int. 2021 Feb;37(2):235-240. doi: 10.1007/s00383-020-04791-0. Epub 2021 Jan 3.
One of the main causes of stricture at hepaticojejunostomy site after surgery for congenital biliary dilatation is inflammation or infection associated with bile leak. The aim of this study was to determine the risk factors and outcomes of bile leak after laparoscopic surgery.
We retrospectively reviewed the demographics and outcomes of patients who underwent laparoscopic surgery for congenital biliary dilatation between September 2013 and December 2019. Data from patients with bile leak were compared to data from patients without bile leak.
Fourteen of 78 patients had bile leak. Hepatic duct diameter at anastomosis was the only risk factor of bile leak. Patients with the diameter ≤ 10 mm had higher incidence of bile leak than in patients with the diameter > 10 mm (P = 0.0023). Among them, bile leak occurred more frequently in patients operated on by non-qualified surgeons based on the Japan Society for Endoscopic Surgery endoscopic surgical skill qualification system than by qualified surgeons (P = 0.027). However, none of the patients with bile leak developed anastomotic stricture afterwards.
Although good technical skill is necessary to avoid bile leak in narrow hepatic duct cases (≤ 10 mm), slight bile leak may not result in anastomotic stricture.
先天性胆管扩张症手术后胆肠吻合口狭窄的主要原因之一是与胆漏相关的炎症或感染。本研究旨在确定腹腔镜手术治疗后胆漏的风险因素和结局。
我们回顾性分析了 2013 年 9 月至 2019 年 12 月期间接受腹腔镜手术治疗先天性胆管扩张症的患者的人口统计学和结局数据。将有胆漏的患者的数据与无胆漏的患者的数据进行比较。
78 例患者中有 14 例发生胆漏。吻合口处肝管直径是胆漏的唯一危险因素。直径≤10mm 的患者胆漏发生率高于直径>10mm 的患者（P=0.0023）。其中，根据日本内镜外科学会内镜手术技能资格系统，非合格外科医生手术的患者胆漏发生率高于合格外科医生（P=0.027）。然而，所有胆漏患者均未发生吻合口狭窄。
尽管在处理狭窄肝管（≤10mm）时需要良好的技术技能以避免胆漏，但轻微的胆漏可能不会导致吻合口狭窄。
