Value of hepatic portal reocclusion for the prevention of bile leakage after hepatectomy

doi:10.3877/cma.j.issn.2095-3232.2017.05.005

Abstract

Abstract:

Objective

To investigate the application value of hepatic portal reocclusion for the prevention of bile leakage after hepatectomy.

Methods

In this prospective study, 197 patients who underwent hepatectomy alone in the Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University between March 2014 and November 2014 were recruited. According to the random number talbe method, the patients were divided into the hepatic portal reocclusion group (n=99) and traditional surgery group (n=98). In the hepatic portal reocclusion group, 81 cases were males and 18 females, aged (54±11) years old on average. Among them, 89 cases were diagnosed with primary liver cancer and 10 with benign liver lesions. After the liver resection with Pringle maneuver, the first porta hepatis was reoccluded to elevate the pressure of intrahepatic blie duct, and the bile duct was examined and tightly sutured. In the traditional surgery group, 82 cases were males and 16 females, aged (52±10) years old on average. Among them, 91 cases were diagnosed with primary liver cancer and 7 with benign liver lesions. The liver resection was performed using Pringle maneuver. The informed consents of all patients were obtained and the local ethical committee approval was received. The perioperative status and prognosis were observed and compared between two groups. The hepatic portal occlusion time and operation time between two groups were compared using t test or Kruskal-Wallis rank test. The rates were compared using Chi-square test or Fisher's exact probability test.

Results

The frequency of hepatic portal occlusion in the hepatic portal reocclusion group was 2(1-4), significantly higher than 1(1-3) in the traditional surgery group (Z=0.000, P<0.05). The hepatic portal occlusion time in the hepatic portal reocclusion group was (21±10) min, significantly longer than (17±9) min in the traditional surgery group (t=0.001, P<0.05). The postoperative length of hospital stay in the hepatic portal reocclusion group was (8±3) d, significantly shorter than (9±3) d in the traditional surgery group (t=-0.040, P<0.05). The incidence of postoperative bile leakage in the hepatic portal reocclusion group was 1%(1/99), significantly lower than 9%(9/98) in the traditional surgery group (χ²=6.830, P<0.05). The symptoms of bile leakage were effectively controlled after short-term drainage.

Conclusions

Application of hepatic portal reocclusion can effectively reduce the incidence of bile leakage after hepatectomy, and provides a simple and efficacious approach to prevent the incidence of bile leakage for the surgeons.

Key words: Hepatectomy, Biliary fistula, Hepatic portal reocclusion

Junyong Ma, Xiaofeng Zhang, Zhenlin Yan, Kui Wang, Yu Wang, Wenchao Wang, Qiang Yan, Feng Shen, Lehua Shi, Xifeng Li. Value of hepatic portal reocclusion for the prevention of bile leakage after hepatectomy[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2017, 06(05): 353-357.

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Figures/Tables 3

References 20

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组别	例数	肝门阻断次数	肝门阻断时间（min，±s）	肝创面对拢缝合（例）	使用生物胶（例）	术中输血（例）	术中输血量（ml，±s）	术中出血量[ml, M(Q_R)]	手术时间（min，±s）	术后住院时间（d，±s）
肝门再次阻断组	99	2（1～4）	21±10	94	87	14	650±309	200（150～300）	129±14	8±3
传统术式组	98	1（1～3）	17±90	92	82	16	614±288	200（100～300）	126±18	9±3
统计值	?	Z=0.000	t=0.001	χ²=0.740	χ²=0.400	χ²=0.670	t=0.760	Z=0.741	t=0.120	t=-0.040
P值	?	<0.05	<0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	<0.05

组别	例数	肝门阻断次数	肝门阻断时间（min，±s）	肝创面对拢缝合（例）	使用生物胶（例）	术中输血（例）	术中输血量（ml，±s）	术中出血量[ml, M(Q_R)]	手术时间（min，±s）	术后住院时间（d，±s）
肝门再次阻断组	99	2（1～4）	21±10	94	87	14	650±309	200（150～300）	129±14	8±3
传统术式组	98	1（1～3）	17±90	92	82	16	614±288	200（100～300）	126±18	9±3
统计值	?	Z=0.000	t=0.001	χ²=0.740	χ²=0.400	χ²=0.670	t=0.760	Z=0.741	t=0.120	t=-0.040
P值	?	<0.05	<0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	<0.05

组别	例数	ALT[U/L, M(Q_R)]			AST[U/L, M(Q_R)]			TB[μmol/L, M(Q_R)]
组别	例数	术后1 d	术后5 d	术后1个月	术后1 d	术后5 d	术后1个月	术后1 d	术后5 d	术后1个月
肝门再次阻断组	99	298(179～529)	63(38～104)	32(21～52)	104(61～221)	27(20～42)	19(16～24)	29(20～38)	17(13～22)	12(10～17)
传统术式组	98	381(207～677)	73(42～128)	28(18～50)	124(73～221)	32(21～43)	21(17～27)	30(21～39)	20(14～25)	13(10～17)
统计值	?	Z=-0.140	Z=-0.230	Z=0.520	Z=-0.850	Z=-0.190	Z=-0.290	Z=-0.080	Z=-0.090	Z=-0.370
P值	?	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05
组别	例数	ALB（g/L，±s）			前白蛋白（g/L，±s）			PT（s，±s）
组别	例数	术后1 d	术后5 d	术后1个月	术后1 d	术后5 d	术后1个月	术后1 d	术后5 d	术后1个月
肝门再次阻断组	99	33±4	36±3	39±3	110±38	145±44	211±63	14.4±2.4	12.7±0.9	12.4±0.8
传统术式组	98	34±4	35±3	40±3	113±38	147±46	228±72	13.9±1.5	12.5±1.0	12.2±0.8
统计值	?	t=-0.080	t=0.200	t=-0.090	t=-0.630	t=-0.770	t=-0.070	t=0.080	t=0.200	t=0.180
P值	?	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

组别	例数	ALT[U/L, M(Q_R)]			AST[U/L, M(Q_R)]			TB[μmol/L, M(Q_R)]
组别	例数	术后1 d	术后5 d	术后1个月	术后1 d	术后5 d	术后1个月	术后1 d	术后5 d	术后1个月
肝门再次阻断组	99	298(179～529)	63(38～104)	32(21～52)	104(61～221)	27(20～42)	19(16～24)	29(20～38)	17(13～22)	12(10～17)
传统术式组	98	381(207～677)	73(42～128)	28(18～50)	124(73～221)	32(21～43)	21(17～27)	30(21～39)	20(14～25)	13(10～17)
统计值	?	Z=-0.140	Z=-0.230	Z=0.520	Z=-0.850	Z=-0.190	Z=-0.290	Z=-0.080	Z=-0.090	Z=-0.370
P值	?	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05
组别	例数	ALB（g/L，±s）			前白蛋白（g/L，±s）			PT（s，±s）
组别	例数	术后1 d	术后5 d	术后1个月	术后1 d	术后5 d	术后1个月	术后1 d	术后5 d	术后1个月
肝门再次阻断组	99	33±4	36±3	39±3	110±38	145±44	211±63	14.4±2.4	12.7±0.9	12.4±0.8
传统术式组	98	34±4	35±3	40±3	113±38	147±46	228±72	13.9±1.5	12.5±1.0	12.2±0.8
统计值	?	t=-0.080	t=0.200	t=-0.090	t=-0.630	t=-0.770	t=-0.070	t=0.080	t=0.200	t=0.180
P值	?	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

组别	例数	胆漏	大出血	膈下积液	胸腔积液	切口感染	急性肝衰竭	急性肾衰竭	肺部并发症
肝门再次阻断组	99	1%（1/99）	2%（2/99）	17%（17/99）	13%（13/99）	1%（1/99）	0	0	3%（3/99）
传统术式组	98	9%（9/98）	4%（4/98）	21%（21/98）	17%（17/98）	2%（2/98）	1%（1/98）	1%（1/98）	2%（2/98）
χ²	?	6.830	0.690	0.520	0.630	0.340	-	-	0.210
P	?	<0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

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