Lo C M, Fan S T, Liu C L, Lai E C, Wong J
Department of Surgery, Queen Mary Hospital, University of Hong Kong, People's Republic of China.
Arch Surg. 1998 Feb;133(2):156-61. doi: 10.1001/archsurg.133.2.156.
To identify the risk factors for the development of biliary complications after hepatic resection and to evaluate management in relation to the outcomes of these patients.
Biliary complications are a common cause of major morbidity after hepatic resection. A survey was made of all patients undergoing hepatic resection at 1 institution. Perioperative risk factors related to the development of biliary complications were identified using multivariate analysis. Management and outcome were analyzed also.
A tertiary referral center.
From January 1, 1989, to October 31, 1995, 347 consecutive patients underwent 229 major and 118 minor hepatic resections.
Development of postoperative biliary complications.
Biliary complications developed in 28 (8.1%) of 347 patients; these complications carried high risks for liver failure (35.7%) and operative mortality (39.3%). Stepwise logistic regression analysis identified increasing age, higher preoperative white blood cell count, left-sided hepatectomy, and prolonged operation time as the independent predictors of development of biliary complications. Conservative treatment or nonoperative measures alone, such as percutaneous drainage or endoscopic therapy, were effective in treating the complication in 13 of 19 patients, but those who required reoperation had a high mortality rate (7 [77.8%] of 9 patients). Patients with demonstrable leakage from the common bile duct or its bifurcation tended to have poor outcomes.
Biliary complications are a common and serious cause of morbidity after hepatic resection. Preresection cholangiography for finding biliary tract anomaly is recommended before left-sided hepatectomy. Although nonoperative measures are the preferred approach for selected patients with biliary complications, those with demonstrable leakage from the common bile duct or its bifurcation have a grave prognosis and may benefit from early surgical intervention.
确定肝切除术后发生胆道并发症的危险因素，并评估针对这些患者的治疗措施及其预后。
胆道并发症是肝切除术后主要发病的常见原因。对一家机构中所有接受肝切除的患者进行了一项调查。采用多因素分析确定与胆道并发症发生相关的围手术期危险因素。同时分析了治疗措施和预后情况。
一家三级转诊中心。
从1989年1月1日至1995年10月31日，347例连续患者接受了229例大肝切除和118例小肝切除。
术后胆道并发症的发生情况。
347例患者中有28例（8.1%）发生了胆道并发症；这些并发症导致肝衰竭（35.7%）和手术死亡率（39.3%）的风险很高。逐步逻辑回归分析确定年龄增加、术前白细胞计数升高、左半肝切除和手术时间延长是胆道并发症发生的独立预测因素。单纯保守治疗或非手术措施，如经皮引流或内镜治疗，对19例患者中的13例有效，但需要再次手术的患者死亡率很高（9例患者中有7例[77.8%]）。胆总管或其分支有明显渗漏的患者预后往往较差。
胆道并发症是肝切除术后常见且严重的发病原因。建议在左半肝切除术前进行术前胆管造影以发现胆道异常。虽然非手术措施是部分胆道并发症患者的首选治疗方法，但胆总管或其分支有明显渗漏的患者预后严重，可能从早期手术干预中获益。
