目的

探讨肝中心型肿瘤切除术后胆漏的影响因素及防治措施。

方法

回顾性分析2017 年7 月至2023 年7 月在哈尔滨医科大学附属第一医院行肝部分切除术的148 例肝中心型肿瘤患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男54 例，女94 例；年龄25～75 岁，中位年龄50 岁。原发病：肝细胞癌27 例，肝血管瘤109 例，肝内胆管癌6 例，非典型增生结节4 例，肝包虫1 例，黑色素瘤1 例。根据术后有无胆漏将患者分为胆漏组和无胆漏组。采用单因素及Logistic多因素回归分析术后胆漏的危险因素。

结果

患者均顺利完成手术，手术时间中位数4.0（1.0～9.0）h，术中出血量248（10～4 000）ml。术后胆漏发生率10.8%（16/148），术后胆漏发生时间5.6（2.0～12.0）d，1 例采用腹腔引流联合胆管支架治愈，其余15 例均通过腹腔引流方式治愈。单因素分析显示，年龄、性别、术前AST、术前ALB、ICGR15、恶性肿瘤、糖尿病、病毒性肝炎、手术时间、术后TB、术后ALT、术后AST、术后ALB、术后活化部分凝血活酶时间（APTT）与术后胆漏发生有关（P＜0.05）。Logistic 多因素回归分析显示，手术时间是肝中叶肿瘤切除术后胆漏的独立危险因素（OR=2.57，95%CI：1.33～4.97；P＜0.05）。

结论

手术时间是肝中心型肿瘤切除术患者发生术后胆漏的独立危险因素，围手术期应积极改善患者基础状态，了解患者影像学资料，缩短手术时间。

Objective

To investigate the risk factors and preventive measures for bile leakage after surgical resection of central hepatic tumors.

Methods

Clinical data of 148 patients with central hepatic tumors who underwent partial hepatectomy in the First Affiliated Hospital of Harbin Medical University from July 2017 to July 2023 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them, 54 patients were male and 94 female,aged from 25 to 75 years, with a median age of 50 years.Primary diseases: 27 patients were diagnosed with hepatocellular carcinoma, 109 cases of hepatic hemangioma, 6 cases of intrahepatic cholangiocarcinoma,4 cases of atypical hyperplasia nodules, 1 case of hepatic echinococcosis and 1 case of melanoma.All patients were divided into the bile leakage and non-bile leakage groups according to the incidence of bile leakage after surgery.The risk factors of postoperative bile leakage were determined by univariate and multivariate Logistic regression analyses.

Results

All patients successfully completed procedures.The median operation time was 4.0(1.0-9.0) h, and intraoperative blood loss was 248(10-4 000) ml.The incidence of postoperative bile leakage was 10.8%(16/148), and the incidence time of bile leakage was 5.6(2.0-12.0) d after surgery.One patient was cured by abdominal drainage combined with biliary stent, and the remaining 15 cases were treated with abdominal drainage.Univariate analysis showed that age, gender, preoperative AST and ALB levels, ICGR15, malignant tumor, diabetes mellitus, viral hepatitis, operation time, postoperative TB, ALT, AST, ALB and activated partial thromboplastin time (APTT) levels were associated with the incidence of postoperative bile leakage (all P＜0.05).Multivariate Logistic regression analysis revealed that operation time was an independent risk factor for bile leakage after surgical resection of central liver tumors(OR=2.57, 95%CI: 1.33-4.97, P＜0.05).

Conclusions

Operation time is an independent risk factor for bile leakage in patients after surgical resection of central liver tumors.During perioperative period, extensive efforts should be made to improve basic status of patients, understand imaging data of patients and shorten operation time.