Clinical analysis of bile leakage after surgical resection of central hepatic tumors

doi:10.3877/cma.j.issn.2095-3232.2025018

Abstract

Abstract:

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.

Key words: Liver neoplasms, Hepatectomy, Mesohepatectomy, Bile leakage, Abdominal drainage, Plasma albumin

Jiajun Li, Sile Wan, Chaoyang Lu. Clinical analysis of bile leakage after surgical resection of central hepatic tumors[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(01): 87-91.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3232.2025018

https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/Y2025/V14/I01/87

Figures/Tables 1

临床指标	胆漏组	无胆漏组	统计值	P值
性别（例，男/女）	10/6	44/88	χ²=7.40	0.02
年龄（岁， $\overset{ˉ}{x}$ ±s）	56±7	50±10	t=2.52	0.02
BMI（kg/m²， $\overset{ˉ}{x}$ ±s）	24.3±2.4	23.8±3.2	t=0.59	0.56
术前TB[μmol/L，M（Q₁，Q₃）]	14（9，16）	12（9，14）	Z=1.12	0.26
术前ALT[U/L，M（Q₁，Q₃）]	21（14，45）	16（11，28）	Z=1.61	0.12
术前AST[U/L，M（Q₁，Q₃）]	26（16，39）	17（14，23）	Z=2.50	0.01
术前ALB[g/L，M（Q₁，Q₃）]	40（38，41）	41（39，43）	Z=-2.50	0.01
术前APTT[s，M（Q₁，Q₃）]	27（26，28）	27（25，28）	Z=0.44	0.66
术前Hb[g/L，M（Q₁，Q₃）]	136（129，144）	136（123，146）	Z=0.33	0.74
ICGR15[M（Q₁，Q₃）]	0.074（0.047，0.088）	0.040（0.025，0.063）	Z=2.82	0.01
恶性肿瘤（例）	11	24	χ²=21.02	＜0.001
糖尿病（例）	5	5	χ²=17.08	＜0.001
病毒性肝炎（例）	10	17	χ²=23.56	＜0.001
肝脏手术史（例）	3	5	χ²=3.67	0.06
手术时间[h，M（Q₁，Q₃）]	6.8（5.6，8.0）	3.5（2.50，5.00）	Z=5.05	＜0.001
术中输血（例）	11	85	χ²=3.67	0.73
腹腔镜手术（例）	13	107	χ²=0	0.99
术后Hb[g/L，M（Q₁，Q₃）]	128（124，135）	124（112，135）	Z=1.38	0.17
术后TB[μmol/L，M（Q₁，Q₃）]	29（16，42）	16（12，25）	Z=3.37	＜0.001
术后ALT[U/L，M（Q₁，Q₃）]	584（463，755）	296（180，454）	Z=3.97	＜0.001
术后AST[U/L，M（Q₁，Q₃）]	576（402，709）	229（127，382）	Z=4.39	＜0.001
术后ALB（g/L， $\overset{ˉ}{x}$ ±s）	31±3	36±4	t=-4.37	＜0.001
术后APTT[s，M（Q₁，Q₃）]	29（26，35）	26（25，28）	Z=3.04	0.01

临床指标	胆漏组	无胆漏组	统计值	P值
性别（例，男/女）	10/6	44/88	χ²=7.40	0.02
年龄（岁， $\overset{ˉ}{x}$ ±s）	56±7	50±10	t=2.52	0.02
BMI（kg/m²， $\overset{ˉ}{x}$ ±s）	24.3±2.4	23.8±3.2	t=0.59	0.56
术前TB[μmol/L，M（Q₁，Q₃）]	14（9，16）	12（9，14）	Z=1.12	0.26
术前ALT[U/L，M（Q₁，Q₃）]	21（14，45）	16（11，28）	Z=1.61	0.12
术前AST[U/L，M（Q₁，Q₃）]	26（16，39）	17（14，23）	Z=2.50	0.01
术前ALB[g/L，M（Q₁，Q₃）]	40（38，41）	41（39，43）	Z=-2.50	0.01
术前APTT[s，M（Q₁，Q₃）]	27（26，28）	27（25，28）	Z=0.44	0.66
术前Hb[g/L，M（Q₁，Q₃）]	136（129，144）	136（123，146）	Z=0.33	0.74
ICGR15[M（Q₁，Q₃）]	0.074（0.047，0.088）	0.040（0.025，0.063）	Z=2.82	0.01
恶性肿瘤（例）	11	24	χ²=21.02	＜0.001
糖尿病（例）	5	5	χ²=17.08	＜0.001
病毒性肝炎（例）	10	17	χ²=23.56	＜0.001
肝脏手术史（例）	3	5	χ²=3.67	0.06
手术时间[h，M（Q₁，Q₃）]	6.8（5.6，8.0）	3.5（2.50，5.00）	Z=5.05	＜0.001
术中输血（例）	11	85	χ²=3.67	0.73
腹腔镜手术（例）	13	107	χ²=0	0.99
术后Hb[g/L，M（Q₁，Q₃）]	128（124，135）	124（112，135）	Z=1.38	0.17
术后TB[μmol/L，M（Q₁，Q₃）]	29（16，42）	16（12，25）	Z=3.37	＜0.001
术后ALT[U/L，M（Q₁，Q₃）]	584（463，755）	296（180，454）	Z=3.97	＜0.001
术后AST[U/L，M（Q₁，Q₃）]	576（402，709）	229（127，382）	Z=4.39	＜0.001
术后ALB（g/L， $\overset{ˉ}{x}$ ±s）	31±3	36±4	t=-4.37	＜0.001
术后APTT[s，M（Q₁，Q₃）]	29（26，35）	26（25，28）	Z=3.04	0.01

References 21

[1]	Bressem KK, Erxleben C, Lauscher JC, et al.Successful CTguided obliteration of isolated bile ducts with ethylene vinyl alcohol copolymer in a patient with chronic bile leakage after hepatectomy[J].J Vasc Interv Radiol, 2019, 30(10):1671-1673.
[2]	Shehta A, Farouk A, Said R, et al.Bile leakage after hepatic resection for hepatocellular carcinoma: does it impact the short- and long-term outcomes?[J].J Gastrointest Surg, 2022, 26(10):2070-2081.
[3]	Xue S, Wang H, Chen X, et al.Risk factors of postoperative bile leakage after liver resection: a systematic review and meta-analysis[J].Cancer Med, 2023, 12(14):14922-14936.
[4]	Martin AN, Narayanan S, Turrentine FE, et al.Clinical factors and postoperative impact of bile leak after liver resection[J].J Gastrointest Surg, 2018, 22(4):661-667.
[5]	Spetzler VN, Schepers M, Pinnschmidt HO, et al.The incidence and severity of post-hepatectomy bile leaks is affected by surgical indications, preoperative chemotherapy, and surgical procedures[J].Hepatobiliary Surg Nutr, 2019, 8(2):101-110.
[6]	Takasaki K.Glissonean pedicle transection method for hepatic resection: a new concept of liver segmentation[J].J Hepatobiliary Pancreat Surg, 1998, 5(3):286-291.
[7]	Tsui TY, Heumann A, Vashist YK, et al.How we do it: double in situ split for staged mesohepatectomy in patients with advanced gall bladder cancer and marginal future liver remnant[J].Langenbeck's Arch Surg, 2016, 401(4):565-571.
[8]	Harimoto N, Muranushi R, Hoshino K, et al.Albumin-Indocyanine Green Evaluation (ALICE) grade predicts bile leakage after hepatic resection[J].Surg Today, 2020, 50(8):849-854.
[9]	Nakagawa K, Tanaka K, Nojiri K, et al.Predictive factors for bile leakage after hepatectomy for hepatic tumors: a retrospective multicenter study with 631 cases at Yokohama Clinical Oncology Group (YCOG)[J].J Hepatobiliary Pancreat Sci, 2017, 24(1): 33-41.
[10]	Sadamori H, Yagi T, Shinoura S, et al.Risk factors for major morbidity after liver resection for hepatocellular carcinoma[J].Br J Surg, 2013,100(1):122-129.
[11]	Sadamori H, Yagi T, Matsuda H, et al.Intractable bile leakage after hepatectomy for hepatocellular carcinoma in 359 recent cases[J].Dig Surg, 2012, 29(2):149-156.
[12]	岳树强.肝切除术后胆漏的诊断与治疗[J/OL].中华肝脏外科手术学电子杂志, 2013, 2(2):128-130.
[13]	Yamashita YI, Yamamoto H, Miyata H, et al.Risk factors for bile leakage: latest analysis of 10 102 hepatectomies for hepatocellular carcinoma from the Japanese national clinical database[J].J Hepato Biliary Pancreat Sci, 2021, 28(7):556-562.
[14]	邓仲鸣, 孙权.肝切除术后并发胆漏危险因素及防治措施分析[J].中国临床研究, 2016, 29(2):204-206.
[15]	吴忠卫.肝胆手术后胆漏的相关因素分析[J].中国现代手术学杂志,2014, 18(4):260-262.
[16]	张胜龙, 杨先伟, 王文涛.泡型肝包虫病肝切除术后胆漏发生危险因素分析[J].中华普通外科杂志, 2020, 35(1):26-29.
[17]	Tuysuz U, Aktas H, Batı IB, et al.The role of Intraoperative cholangiography (IOC) and methylene blue tests in reducing bile leakage after living donor hepatectomy[J].Asian J Surg, 2021, 44(1):147-152.
[18]	Chiara O, Cimbanassi S, Bellanova G, et al.A systematic review on the use of topical hemostats in trauma and emergency surgery[J].BMC Surg, 2018, 18(1):68.
[19]	Zimmitti G, Vauthey JN, Shindoh J, et al.Systematic use of an intraoperative air leak test at the time of major liver resection reduces the rate of postoperative biliary complications[J].J Am Coll Surg,2013, 217(6):1028-1037.
[20]	Hayashi K, Abe Y, Shinoda M, et al.Clinical impact of intraoperative bile leakage during laparoscopic liver resection[J].Surg Endosc, 2021,35(8):4134-4142.
[21]	Chopinet S, Bollon E, Hak JF, et al.The white test for intraoperative screening of bile leakage: a potential trigger factor for acute pancreatitis after liver resection-a case series[J].BMC Surg, 2021,21(1):356.

Please choose a citation manager

Content to export