Braunwarth Eva, Ratti Francesca, Aldrighetti Luca, Al-Saffar Hasan A, D Souza Melroy A, Sturesson Christian, Linke Richard, Schnitzbauer Andreas, Bodingbauer Martin, Kaczirek Klaus, Vagg Daniel, Toogood Giles, Ferraro Daniele, Fusai Giuseppe K, Diaz-Nieto Rafael, Malik Hassan, Hoogwater Frederik J H, Wagner Doris, Kornprat Peter, Fischer Ines, Függer Reinhold, Göbel Georg, Öfner Dietmar, Stättner Stefan
Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria.
Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy.
HPB (Oxford). 2023 Jan;25(1):54-62. doi: 10.1016/j.hpb.2022.08.009. Epub 2022 Aug 25.
Anastomotic leak (AL) after bilioenteric reconstruction (BR) is a feared complication after bile duct resection, especially in combination with liver resection. Literature on surgical outcome is sparse. This study aimed to determine the incidence and risk factors for AL after combined liver and bile duct resection with a focus on operative or endoscopic reinterventions.
Data from consecutive patients who underwent liver resection and BR between 2004 and 2018 in 11 academic institutions in Europe were collected from prospectively maintained databases.
Within 921 patients, AL rate was 5.4% with a 30d mortality of 9.6%. Pringle maneuver (p<0.001),postoperative external biliary (p=0.007) and abdominal drainage (p<0.001) were risk factors for clinically relevant AL. Preoperative biliary drainage (p<0.001) was not associated with a higher rate of AL. AL was more frequent in stented patients (76.5%) compared to PTCD (17.6%) or PTCD+stent (5.9%,p=0.017). AL correlated with increased incidence of postoperative liver failure (p=0.036), cholangitis, hemorrhage and sepsis (all p<0.001).
This multicenter data provides the largest series to date of LR with BR and could help in the management of these patients which are often challenging and hampering the patients' postoperative course negatively.
胆肠重建术后吻合口漏（AL）是胆管切除术后令人担忧的并发症，尤其是在联合肝切除的情况下。关于手术结果的文献较少。本研究旨在确定联合肝切除和胆管切除术后AL的发生率及危险因素，重点关注手术或内镜再次干预情况。
从欧洲11家学术机构前瞻性维护的数据库中收集2004年至2018年期间接受肝切除和胆肠重建的连续患者的数据。
在921例患者中，AL发生率为5.4%，30天死亡率为9.6%。Pringle手法（p<0.001）、术后外引流（p=0.007）和腹腔引流（p<0.001）是临床相关AL的危险因素。术前胆管引流（p<0.001）与较高的AL发生率无关。与经皮肝穿刺胆管引流（PTCD，17.6%）或PTCD+支架置入（5.9%，p=0.017）相比，支架置入患者中AL更常见（76.5%）。AL与术后肝衰竭（p=0.036）、胆管炎、出血和脓毒症（均p<0.001）的发生率增加相关。
这项多中心数据提供了迄今为止联合肝切除和胆肠重建的最大病例系列，有助于管理这些通常具有挑战性且对患者术后病程产生负面影响的患者。
