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中华肝脏外科手术学电子杂志 ›› 2025, Vol. 14 ›› Issue (02) : 256 -261. doi: 10.3877/cma.j.issn.2095-3232.2025044

临床研究

转化治疗后肝癌肝切除患者术后自发性胆漏发生原因初步探讨
杨陈凤麟1, 张潇2, 丁洁茹3, 胡文1, 李尧1, 陈品初1, 王泽桐1, 张起帆1,()   
  1. 1. 510515 广州,南方医科大学南方医院普通外科学肝胆胰外科
    2. 510515 广州,南方医科大学第一临床医学院
    3. 510280 广州,南方医科大学第二临床医学院
  • 收稿日期:2024-11-28 出版日期:2025-04-10
  • 通信作者: 张起帆
  • 基金资助:
    广东省自然科学基金面上项目(2021A151511015)南方医科大学2024年省级大学生创新训练计划项目(S202412121152)

Preliminary study of causes of spontaneous bile leakage in hepatocellular carcinoma patients undergoing hepatectomy after conversion therapy

Fenglin Yang-Chen1, Xiao Zhang2, Jieru Ding3, Wen Hu1, Yao Li1, Pinchu Chen1, Zetong Wang1, Qifan Zhang1,()   

  1. 1. Division of Hepatobiliopancreatic Surgery,Department of General Surgery,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China
    2. The First Clinical Medical College of Southern Medical University,Guangzhou 510515,China
    3. The Second Clinical Medical College of Southern Medical University,Guangzhou 510280,China
  • Received:2024-11-28 Published:2025-04-10
  • Corresponding author: Qifan Zhang
引用本文:

杨陈凤麟, 张潇, 丁洁茹, 胡文, 李尧, 陈品初, 王泽桐, 张起帆. 转化治疗后肝癌肝切除患者术后自发性胆漏发生原因初步探讨[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 256-261.

Fenglin Yang-Chen, Xiao Zhang, Jieru Ding, Wen Hu, Yao Li, Pinchu Chen, Zetong Wang, Qifan Zhang. Preliminary study of causes of spontaneous bile leakage in hepatocellular carcinoma patients undergoing hepatectomy after conversion therapy[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(02): 256-261.

目的

探索转化治疗与肝细胞癌(肝癌)切除术后自发性胆漏发生原因。

方法

回顾性分析2022 年10 至2023 年9 月在南方医科大学南方医院行腹腔镜肝癌肝切除术的41 例患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男31 例,女10 例;年龄28~73 岁,中位年龄60 岁。根据术前是否采用转化治疗,分为转化组(10 例)和非转化组(31 例)。转化治疗方案采用TACE、肝动脉灌注化疗联合靶向免疫药物。两组手术时间、术后住院时间等比较采用Man-Whitney U 检验。胆漏发生率比较采用Fisher 确切概率法。

结果

转化组术后胆漏发生率为40%(4/10),非转化组无胆漏发生,差异有统计学意义(P=0.002)。转化组手术时间为222(168,277)min,明显长于非转化组的146(99,208)min(Z=2.478,P<0.05);转化组术后住院时间和引流管留置时间分别为11.9(8.3 ,12.8)、11.0(8.0,14.0) d,亦明显长于非转化组的8.9(7.6,10.4)、7.0(4.0,10.0) d(Z=1.372,2.163,P<0.05)。病理组织切片发现,转化治疗后患者在癌周(非切缘)组织中,肝汇管区附近分布大量炎细胞,同时肝细胞有严重水肿和细胞内淤胆,胆管出现胆汁漏,而管腔结构基本完整。

结论

经转化治疗的肝癌患者根治性切除术后胆漏发生率增加,可能与转化治疗后肝脏组织结构和质地变化相关,对于此类患者,术后应密切监视引流情况,适当延长引流管留置时间。

Objective

To investigate the causes of spontaneous bile leakage in hepatocellular carcinoma (HCC) patients undergoing hepatectomy after conversion therapy.

Methods

Clinical data of 41 HCC patients who underwent laparoscopic hepatectomy in Nanfang Hospital of Southern Medical University from October 2022 to September 2023 were analyzed retrospectively.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them, 31 patients were male and 10 female, aged from 28 to 73 years, with a median age of 60 years.All patients were divided into the conversion therapy group (n=10 cases) and non-conversion therapy group (n=31) according to whether conversion therapy was performed before operation.TACE, hepatic arterial infusion chemotherapy combined with targeted immunotherapy were adopted in the conversion therapy.The operation time and the length of postoperative hospital stay between two groups were compared by Man-Whitney U test.The incidence of bile leakage was compared by Fisher’s exact test.

Results

The incidence of postoperative bile leakage was 40%(4/10)in the conversion therapy group, and no bile leakage was reported in the non-conversion therapy group, and the difference was statistically significant between two groups (P=0.002).In the conversion therapy group,the operation time was 222 (168,277) min, significantly longer than 146 (99,208) min in the non-conversion therapy group (Z=2.478, P<0.05).In the conversion therapy group, the length of postoperative hospital stay and time of indwelling drainage catheter were 11.9 (8.3, 12.8) and 11.0 (8.0, 14.0) d, significantly longer than 8.9 (7.6, 10.4) and 7.0 (4.0, 10.0) d in the non-conversion therapy group (Z=1.372, 2.163, both P<0.05).

Pathological examination showed that a large number of inflammatory cells were distributed adjacent to the portal area of liver in the paracancerous (non-surgical margin) tissues of patients after conversion treatment.Severe edema of liver cells and intracellular cholestasis were noted.Bile leakage occurred in the bile duct,and the lumen structure was basically intact.

Conclusions

The increased incidence of bile leakage in HCC patients undergoing radical resection after conversion therapy is probably correlated with the changes of liver tissue structure and texture after conversion therapy.For these patients, the drainage situation should be closely monitored after operation and the time of indwelling drainage catheter should be appropriately prolonged.

表1 两组肝癌肝切除患者一般资料比较
表2 两组肝癌肝切除患者围手术期指标比较
图1 一例转化治疗组肝癌肝切除术后胆漏患者病理图片 注:a 为小叶间胆管淤胆(HE ×100),b 为汇管区炎细胞浸润(HE ×100),c 为肝细胞淤胆(HE ×400)
表3 肝癌肝切除术后胆漏患者临床资料和转化治疗方案
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