对肝切除术后胆漏的 ISGLS 定义的批判性评价。
A critical appraisal of the ISGLS definition of biliary leakage after liver resection.
机构信息
Department for General, Visceral and Transplant Surgery, University Hospital Frankfurt, Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany.
Institute of Physiology, University of Zurich, Zurich, Switzerland.
出版信息
Langenbecks Arch Surg. 2023 Feb 3;408(1):77. doi: 10.1007/s00423-022-02746-8.
PURPOSE
The International Study Group of Liver Surgery (ISGLS) defined post-hepatectomy biliary leakage as drain/serum bilirubin ratio > 3 at day 3 or the interventional/surgical revision due to biliary peritonitis. We investigated the definition's applicability.
METHODS
A retrospective evaluation of all liver resections over a 6-year period was performed. ROC analyses were performed for drain/serum bilirubin ratios on days 1, 2, and 3 including grade A to C (analysis I) and grade B and C biliary leakages (analysis II) to test specific cutoff values.
RESULTS
A total of 576 patients were included. One hundred nine (18.9%) postoperative bile leakages occurred (19.6% of the whole population grade A, 16.5% grade B/C). Areas under the curve (AUC) for analysis I were 0.841 (day 1), 0.846 (day 2), and 0.734 (day 3). The highest sensitivity (78% on day 1/77% on day 2) and specificity (78% on day 1/79% on day 2) in analysis I were obtained for a drain/serum bilirubin ratio of 2.0. AUCs for analysis II were similar: 0.788 (day 1), 0.791 (day 2), and 0.650 (day 3). The highest sensitivity (73% on day 1/71% on day 2) and specificity (74% on day 1/76% on day 2) in analysis II were detected for a drain/serum bilirubin ratio of 2.0 on postoperative day 2.
CONCLUSION
Biliary leakages should be defined if the drain/serum bilirubin ratio is > 2.0 on postoperative day 2.
目的
国际肝脏外科研究组（ISGLS）将术后第 3 天胆汁引流量/血清胆红素比值>3 或因胆汁性腹膜炎而行介入/手术修正定义为术后胆漏。本研究旨在验证该定义的适用性。
方法
对 6 年内所有行肝切除术患者进行回顾性评估。对术后第 1、2、3 天的胆汁引流量/血清胆红素比值进行 ROC 分析，包括 A 至 C 级（分析 I）和 B 级及 C 级胆漏（分析 II），以检测特定的截断值。
结果
共纳入 576 例患者。术后发生 109 例（18.9%）胆漏（总体人群中 A 级 19.6%，B/C 级 16.5%）。分析 I 的 AUC 为 0.841（第 1 天）、0.846（第 2 天）和 0.734（第 3 天）。分析 I 中，胆汁引流量/血清胆红素比值为 2.0 时，其灵敏度（第 1 天 78%，第 2 天 77%）和特异性（第 1 天 78%，第 2 天 79%）最高。分析 II 的 AUC 相似：0.788（第 1 天）、0.791（第 2 天）和 0.650（第 3 天）。胆汁引流量/血清胆红素比值为 2.0 时，分析 II 中第 1 天和第 2 天的灵敏度（73%和 71%）和特异性（74%和 76%）最高。
结论
术后第 2 天，胆汁引流量/血清胆红素比值>2.0 时应定义为胆漏。
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