Risk factors of biliary fistula in patients with cystic echinococcosis

doi:10.3877/cma.j.issn.2095-3232.2020.03.010

Abstract

Abstract:

Objective

To investigate the risk factors of cystobiliary fistula (CBF) in patients with cystic echinococcosis.

Methods

Clinical data of 145 patients with cystic echinococcosis admitted to Xinjiang Uiger Municipal People's Hospital from January 2016 to December 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 70 patients were male and 75 female, aged (41±18) years old. Univariate analysis of the incidence of CBF in patients with cystic echinococcosis was performed by t test, rank sum test and Chi-square test. The independent risk factors for CBF were identified by multivariate Logistic regression analysis.

Results

The incidence of CBF in all patients was 27.6% (40/145). The CBF of 12 cases was found by abdominal imaging examination, 18 cases was found during the operation and 10 cases after the operation. Univariate analysis demonstrated that the incidence of CBF was significantly correlated with preoperative jaundice, cholangitis, number of cysts, type of hepatic echinococcosis and surgical methods (χ2= 4.56, 6.58, 7.86, 5.67, 6.58; P<0.05), ALP, GGT (Z=6.57, 4.38; P<0.05), cyst diameter (t=4.78, P<0.05). Multivariate analysis showed that ALP>81 U/L, GGT>50 U/L and cyst diameter>8 cm were the independent risk factors for CBF (OR=1.112, 1.134, 1.025; P<0.05).

Conclusions

Preoperative ALP, GGT and cyst diameter are the risk factors for CBF in patients with cystic echinococcosis.

Key words: Echinococcosis, hepatic, Biliary fistula, Risk factors

Kalifu Baheti, Yuan Meng, Lunjian Chen, Zhigang Ma, Jingguo Wang, Wei Song, Guanglei Tian, Xiong Chen. Risk factors of biliary fistula in patients with cystic echinococcosis[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2020, 09(03): 244-248.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3232.2020.03.010

https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/Y2020/V09/I03/244

Figures/Tables 2

References 25

[1]	Menezes da Silva A. Hydatid cyst of the liver-criteria for the selection of appropriate treatment[J]. Acta Trop, 2003, 85(2):237-242.
[2]	Avcu S, Ünal Ö, Arslan H. Intrabiliary rupture of liver hydatid cyst:a case report and review of the literature[J]. Cases J, 2009(2):6455.
[3]	Erzurumlu K, Dervisoglu A, Polat C, et al. Intrabiliary rupture: an algorithm in the treatment of controversial complication of hepatic hydatidosis[J]. World J Gastroenterol, 2005, 11(16):2472-2476.
[4]	Erden A, Ormeci N, Fitoz S, et al. Intrabiliary rupture of hepatic hydatid cysts: diagnostic accuracy of MR cholangiopancreatography[J]. AJR Am J Roentgenol, 2007, 189(2): W84-89.
[5]	冉博，温浩，吐尔干·艾力，等．肝囊型包虫病术后顽固性残腔胆瘘术式探讨[J]．中华肝胆外科杂志，2013, 19(4):539-541．
[6]	蒋铁民，杨登，冉博，等．双"T"型管引流治疗肝包虫破入胆总管[J]．中华肝胆外科杂志，2017, 24(8):539-541．
[7]	Brunetti E, Kern P, Vuitton DA, et al. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans[J]. Acta Trop, 2010, 114(1):1-16.
[8]	El Malki HO, El Mejdoubi Y, Souadka A, et al. Predictive model of biliocystic communication in liver hydatid cysts using classification and regression tree analysis[J]. BMC Surg, 2010, 10:16.
[9]	Atahan K, Küpeli H, Deniz M, et al. Can occult cystobiliary fistulas in hepatic hydatid disease be predicted before surgery[J]. Int J Med Sci, 2011, 8(4):315-320.
[10]	Kilic M, Yoldas O, Koc M, et al. Can biliary-cyst communication be predicted before surgery for hepatic hydatid disease: does size matter?[J]. Am J Surg, 2008, 196(5):732-735.
[11]	Secchi MA, Pettinari R, Mercapide C, et al. Surgical management of liver hydatidosis: a multicentre series of 1412 patients[J]. Liver Int, 2010, 30(1):85-93.
[12]	Benkabbou A, Souadka A, Serji B, et al. Changing paradigms in the surgical management of cystic liver hydatidosis improve the postoperative outcomes[J]. Surgery, 2016, 159(4):1170-1180.
[13]	Saylam B, Coşkun F, Demiriz B, et al. A new and simple score for predicting cystobiliary fistula in patients with hepatic hydatid cysts[J]. Surgery, 2013, 153(5):699-704.
[14]	Ramia JM, Figueras J, De la Plaza R, et al. Cysto-biliary communication in liver hydatidosis[J]. Langenbecks Arc Surg, 2012, 397(6):881-887.
[15]	Manouras A, Genetzakis M, Antonakis PT, et al. Endoscopic management of a relapsing hepatic hydatid cyst with intrabiliary rupture: a case report and review of the literature[J]. Can J Gastroenterol, 2007, 21(4):249-253.
[16]	Demircan O, Baymus M, Seydaoglu G, et al. Occult cystobiliary communication presenting as postoperative biliary leakage after hydatid liver surgery: are there significant preoperative clinical predictors?[J]. Can J Surg, 2006, 49(3):177-184.
[17]	Kayaalp C, Bostanci B, Yol S, et al. Distribution of hydatid cysts into the liver with reference to cystobiliary communications and cavityrelated complications[J]. Am J Surg, 2003, 185(2):175-179.
[18]	Prousalidis J, Kosmidis C, Kapoutzis K, et al. Intrabiliary rupture of hydatid cysts of the liver[J]. Am J Surg, 2009, 197(2):193-198.
[19]	Yalin R, Aktan AO, Yeğen C, et al. Significance of intracystic pressure in abdominal hydatid disease[J]. Br J Surg, 1992, 79(11): 1182-1183.
[20]	Atli M, Kama NA, Yuksek YN, et al. Intrabiliary rupture of a hepatic hydatid cyst: associated clinical factors and proper management[J]. Arch Surg, 2001, 136(11):1249-1255.
[21]	Ramia JM, Figueras J, De la Plaza R, et al. Cysto-biliary communication in liver hydatidosi[J]. Langenbecks Arch Surg, 2012, 397(6):881-887.
[22]	Unalp HR, Baydar B, Kamer E, et al. Asymptomatic occult cysto-biliary communication without bile into cavity of the liver hydatid cyst: a pitfall in conservative surgery[J]. Int J Surg, 2009, 7(4):387-391.
[23]	Manouras A, Genetzakis M, Antonakis PT, et al. Endoscopic management of a relapsing hepatic hydatid cyst with intrabiliary rupture: a case report and review of the literature[J]. Can J Gastroenterol, 2007, 21(4):249-253.
[24]	Hamamci EO, Besim H, Sonisik M, et al. Occult intrabiliary rupture of hydatid cysts in the liver[J]. World J Surg, 2005, 29(2):224-226.
[25]	Bektaş M, Dökmeci A, Cinar K, et al. Endoscopic management of biliary parasitic diseases[J]. Dig Dis Sci, 2010, 55(5):1472-1478.

参数		CBF组	无CBF组	统计值	P值
年龄（岁，±s）		40±19	42±21	t=-0.85	0.900
性别（例）		?	?	χ²=0.46	0.450
?	男	21	49	?	?
?	女	19	56	?	?
腹痛（例）		32	78	χ²=0.54	0.540
黄疸（例）		9	2	χ²=4.56	0.001
胆管炎（例）		7	0	χ²=6.58	0.001
TB[μmol/L，M(Q_R)]		10.8（1.9～21.3）	6.8（2.0～15.5）	Z=0.84	0.100
DB[μmol/L，M(Q_R)]		9.9（1.9～16.3）	5.3（1.8～7.3）	Z=0.84	0.100
AST[U/L，M(Q_R)]		39.1（11.1～59.2）	27.0（8.1～40.7）	Z=0.92	0.800
ALT[U/L，M(Q_R)]		46.1（10.1～65.2）	35.9（9.1～52.5）	Z=0.89	0.700
ALP[U/L，M(Q_R)]		250（106～601）	81（45～141）	Z=6.57	0.001
GGT[U/L，M(Q_R)]		198（80～400）	50（20～80）	Z=4.38	0.001
囊肿数目（例）		?	?	χ²=7.86	0.001
?	单发	17	64	?	?
?	多发	23	41	?	?
囊肿直径（cm，±s）		16±9	8±4	t=4.78	0.001
囊肿位置（例）		?	?	χ²=0.47	0.700
?	中央型	28	52	?	?
?	周围型	12	53	?	?
肝包虫病类型（例）		?	?	χ²=5.67	0.001
?	Ⅰ型	5	25	?	?
?	Ⅱ型	10	41	?	?
?	Ⅲ型	16	33	?	?
?	Ⅳ型	9	6	?	?
手术类型（例）		?	?	χ²=6.58	0.001
?	根治性切除术	7	49	?	?
?	内囊摘除+外囊大部分切除术	33	56	?	?

参数		CBF组	无CBF组	统计值	P值
年龄（岁，±s）		40±19	42±21	t=-0.85	0.900
性别（例）		?	?	χ²=0.46	0.450
?	男	21	49	?	?
?	女	19	56	?	?
腹痛（例）		32	78	χ²=0.54	0.540
黄疸（例）		9	2	χ²=4.56	0.001
胆管炎（例）		7	0	χ²=6.58	0.001
TB[μmol/L，M(Q_R)]		10.8（1.9～21.3）	6.8（2.0～15.5）	Z=0.84	0.100
DB[μmol/L，M(Q_R)]		9.9（1.9～16.3）	5.3（1.8～7.3）	Z=0.84	0.100
AST[U/L，M(Q_R)]		39.1（11.1～59.2）	27.0（8.1～40.7）	Z=0.92	0.800
ALT[U/L，M(Q_R)]		46.1（10.1～65.2）	35.9（9.1～52.5）	Z=0.89	0.700
ALP[U/L，M(Q_R)]		250（106～601）	81（45～141）	Z=6.57	0.001
GGT[U/L，M(Q_R)]		198（80～400）	50（20～80）	Z=4.38	0.001
囊肿数目（例）		?	?	χ²=7.86	0.001
?	单发	17	64	?	?
?	多发	23	41	?	?
囊肿直径（cm，±s）		16±9	8±4	t=4.78	0.001
囊肿位置（例）		?	?	χ²=0.47	0.700
?	中央型	28	52	?	?
?	周围型	12	53	?	?
肝包虫病类型（例）		?	?	χ²=5.67	0.001
?	Ⅰ型	5	25	?	?
?	Ⅱ型	10	41	?	?
?	Ⅲ型	16	33	?	?
?	Ⅳ型	9	6	?	?
手术类型（例）		?	?	χ²=6.58	0.001
?	根治性切除术	7	49	?	?
?	内囊摘除+外囊大部分切除术	33	56	?	?

变量	P值	OR值	95%CI
黄疸	0.285	1.765	0.707～5.830
ALP>81 U/L	0.010	1.025	1.012～1.352
GGT>50 U/L	0.010	1.112	1.025～1.395
囊肿多发	0.192	2.355	0.834～6.835
囊肿直径>8 cm	0.001	1.134	1.025～1.385

变量	P值	OR值	95%CI
黄疸	0.285	1.765	0.707～5.830
ALP>81 U/L	0.010	1.025	1.012～1.352
GGT>50 U/L	0.010	1.112	1.025～1.395
囊肿多发	0.192	2.355	0.834～6.835
囊肿直径>8 cm	0.001	1.134	1.025～1.385

Please choose a citation manager

Content to export