Shimojo Kota, Iwashita Takuji, Iwata Keisuke, Utakata Yuki, Koide Kaori, Koizumi Takuya, Ito Yuki, Ohashi Yosuke, Iwata Shota, Senju Akihiko, Tezuka Ryuichi, Ichikawa Hironao, Iwasa Yuhei, Mita Naoki, Okuno Mitsuru, Yoshida Kensaku, Maruta Akinori, Uemura Shinya, Kawai Masahiko, Sasaki Yoshiyuki, Murase Katsutoshi, Matsuhashi Nobuhisa, Shimizu Masahito
Department of Gastroenterology Hashima Municipal Hospital Gifu Japan.
First Department of Internal Medicine Gifu University Hospital Gifu Japan.
DEN Open. 2025 Jun 10;6(1):e70161. doi: 10.1002/deo2.70161. eCollection 2026 Apr.
Bile leakage is one of the complications after hepatobiliary surgery, causing intra-abdominal infections, and is sometimes difficult to treat. The purpose of our study was to investigate the factors related to severity and to evaluate the efficacy of endoscopic treatment.
This was a retrospective multicenter cohort study conducted at three tertiary care medical centers. The severity of bile leakage was classified per the International Study Group of Liver Surgery, and Grades B and C (requiring some intervention or reoperation) were considered as severe.
The subjects were 59 patients. The surgical procedures were 31 cholecystectomies, 23 hepatectomies, and five pancreaticoduodenectomies. The severity was Grade A/B/C: 17/40/2. Multivariate logistic regression analysis found that age (unit odds ratio [UOR], 1.09; 95% confidence interval [CI], 1.0-1.19; = 0.049) and days from surgery to bile leak (UOR, 1.18; 95% CI, 1.04-1.35; = 0.012) were independent predictors of bile leak severity. Of 40 Grade B biliary leakage patients, 37 patients underwent endoscopic drainage, of which 11 also received intra-abdominal abscess drainage. Eventually, bile leakage was successfully treated in all patients after several endoscopic drainage sessions, and the median drainage period was 18 days (inter-quartile range: 13-35).
In the management of bile leakage after hepatobiliary surgery, elderly patients or patients with late onset of bile leak may be at high risk of severity. Endoscopic biliary drainage is considered a safe and effective treatment for severe patients.
胆漏是肝胆手术后的并发症之一，可导致腹腔内感染，有时难以治疗。本研究的目的是调查与严重程度相关的因素，并评估内镜治疗的疗效。
这是一项在三家三级医疗中心进行的回顾性多中心队列研究。胆漏的严重程度根据国际肝脏外科学组进行分类，B级和C级（需要一些干预或再次手术）被视为严重。
研究对象为59例患者。手术方式包括31例胆囊切除术、23例肝切除术和5例胰十二指肠切除术。严重程度分级为A/B/C级：17/40/2。多因素逻辑回归分析发现，年龄（单位比值比[UOR]，1.09；95%置信区间[CI]，1.0-1.19；P = 0.049）和从手术到胆漏的天数（UOR，1.18；95%CI，1.04-1.35；P = 0.012）是胆漏严重程度的独立预测因素。40例B级胆漏患者中，37例接受了内镜引流，其中11例还接受了腹腔脓肿引流。最终，经过多次内镜引流，所有患者的胆漏均得到成功治疗，中位引流期为18天（四分位间距：13-35）。
在肝胆手术后胆漏的管理中，老年患者或胆漏发生较晚的患者可能有严重程度较高的风险。内镜胆管引流被认为是治疗严重患者的一种安全有效的方法。
