HPB Surgery, Hepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy.
Department of Radiology, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy.
Surgery. 2021 Aug;170(2):499-506. doi: 10.1016/j.surg.2021.02.018. Epub 2021 Mar 18.
Bile leaks occurring after complex liver resection and lasting >1 week (grade B) usually are managed by means of invasive cholangiography either endoscopic or percutaneous, with a substantial risk of procedure-related complications. The aim of this study was to investigate the ability of gadoxetic acid disodium-enhanced magnetic resonance cholangiography to detect postoperative biliary leaks and avoid invasive cholangiography in case of peripheral location of the fistula.
Patients with grade B biliary leak after complex liver resection from January 2018 to March 2020 underwent magnetic resonance cholangiography to guide the management of the leak (study group). The primary endpoint was the ability of magnetic resonance cholangiography to reduce the need for invasive cholangiography with respect to similar posthepatectomy leaks collected in the previous 2 years and approached with upfront invasive cholangiography (controls). A series of in-hospital outcomes also were compared.
Out of 533 liver resections, 11 study patients versus 11 control patients with grade B leaks were compared. Magnetic resonance cholangiography achieved 100% accuracy in detection and location of the leak. Five out of 6 peripheral leaks healed without invasive cholangiography. Overall, 50% reduction in the use of invasive cholangiography was observed in the study versus control patients. Median healing time and hospital stay were 38 and 40 days in patients undergoing invasive cholangiography versus 10 and 11 days in patients treated conservatively (P = .007 and 0.012, respectively). Infection rate and other complications rate were 82% vs 20% (P = .01) and 35% vs 40% (P = .5), respectively.
Magnetic resonance cholangiography is a safe, precise, noninvasive tool to detect posthepatectomy bile leaks that can help clinicians in decision-making on conservative versus invasive treatment of fistulas.
复杂肝切除术后持续时间>1 周的胆汁漏（B 级）通常通过内镜或经皮侵入性胆管造影术来治疗，这存在相当大的与操作相关的并发症风险。本研究旨在探讨钆塞酸二钠增强磁共振胆管成像检测术后胆漏的能力，并在瘘管位于周边位置时避免侵入性胆管造影术。
2018 年 1 月至 2020 年 3 月期间，11 例复杂肝切除术后发生 B 级胆漏的患者接受磁共振胆管成像检查以指导胆漏的处理（研究组）。主要终点是磁共振胆管成像检查相对于前 2 年采用侵入性胆管造影术治疗的类似肝切除术后胆漏的能力，以及类似肝切除术后胆漏采用侵入性胆管造影术治疗（对照组）。还比较了一系列住院期间的结果。
在 533 例肝切除术中，将 11 例研究患者与 11 例对照患者的 B 级胆漏进行了比较。磁共振胆管成像检查在检测和定位漏口方面达到了 100%的准确率。6 例周边漏口中有 5 例在未行侵入性胆管造影术的情况下愈合。与对照组相比，研究组侵入性胆管造影术的使用率降低了 50%。接受侵入性胆管造影术的患者中位愈合时间和住院时间分别为 38 天和 40 天，而接受保守治疗的患者分别为 10 天和 11 天（P=0.007 和 0.012）。感染率和其他并发症发生率分别为 82%和 20%（P=0.01）和 35%和 40%（P=0.5）。
磁共振胆管成像检查是一种安全、准确、非侵入性的工具，可用于检测肝切除术后胆漏，有助于临床医生在瘘管的保守治疗与侵入性治疗之间做出决策。
