Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China; Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China.
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China.
Int J Surg. 2022 Aug;104:106748. doi: 10.1016/j.ijsu.2022.106748. Epub 2022 Jul 4.
Bile leakage (BL) is a common complication of partial hepatectomy for hepatocellular carcinoma (HCC). However, various intraoperative approaches to detect BL have not been widely accepted owing to uncertainty in their treatment effectiveness and complexity of use.
A novel BL-detection approach (Peng's test) was developed in a swine model to determine the pressures generated in the gallbladder and common bile duct (CBD) during the test. A comparative study was then conducted on a prospective cohort of patients using Peng's test versus a retrospective historical cohort patient group using the White Gauze test in partial hepatectomy for HCC. Propensity score matching (PSM) was performed in a 1:1 ratio to balance confounding factors.
The maximum pressures with methylene blue injection in the gallbladder and CBD without Pringle's maneuver in the four swines were 103.8 ± 11.8 and 42.3 ± 6.1, respectively. After Pringle's maneuver, 32.0 ± 6.8 mL methylene blue injection led to a maximum pressure in the CBD of 85.3 ± 9.5 cmHO. The pressures in CBD were 25.8 ± 3.3 and 86.0 ± 9.9 cmHO when BL appeared at small bile ducts and around the ligation sites, respectively. Of the 206 patients enrolled in the historical control group, 31 (15.0%) developed BL, while of the 54 patients in the study group, only 1 developed grade A BL. The number of BL detected by the routine white gauze test in the control group was significantly lower than that in the study group (Z = -3.002, P = 0.003). After PSM, the incidence of BL in the control group and grade B/C BL was 20.4% and 11.1%, respectively. The corresponding incidences in the study group were 1.9% (χ = 7.594, P = 0.006) and 0% (P = 0.027), respectively. The length of hospital stay in the study group was significantly reduced (Z = -6.048, P < 0.001).
Peng's test for intraoperative BL detection is safe and effective in reducing BL after hepatectomy.
胆漏（BL）是肝细胞癌（HCC）部分肝切除术后的常见并发症。然而，由于其治疗效果的不确定性和使用的复杂性，各种术中检测 BL 的方法尚未被广泛接受。
我们在猪模型中开发了一种新的 BL 检测方法（彭氏试验），以确定试验过程中胆囊和胆总管（CBD）中产生的压力。然后，我们对使用彭氏试验的 HCC 部分肝切除术患者前瞻性队列与使用 White Gauze 试验的回顾性历史队列患者进行了比较研究。采用倾向评分匹配（PSM）以 1:1 的比例平衡混杂因素。
四只猪在不使用普雷令氏手法的情况下，向胆囊和 CBD 内注射亚甲蓝时的最大压力分别为 103.8±11.8 和 42.3±6.1。普雷令氏手法后，向 CBD 内注射 32.0±6.8mL 亚甲蓝时，CBD 内的最大压力为 85.3±9.5cmH2O。当 BL 出现在小胆管和结扎部位周围时，CBD 内的压力分别为 25.8±3.3 和 86.0±9.9cmH2O。在历史对照组的 206 名患者中，有 31 名（15.0%）发生 BL，而在研究组的 54 名患者中，只有 1 名发生 A 级 BL。对照组常规使用白色纱布检测到的 BL 数量明显低于研究组（Z=-3.002，P=0.003）。PSM 后，对照组 BL 发生率为 20.4%，B/C 级 BL 发生率为 11.1%；研究组的发生率分别为 1.9%（χ=7.594，P=0.006）和 0%（P=0.027）。研究组患者的住院时间明显缩短（Z=-6.048，P<0.001）。
彭氏试验用于术中 BL 检测，可安全有效地减少肝切除术后 BL 的发生。
