肝门部胆管癌患者手术切除后胆漏的影响因素分析

Analysis of risk factors of postoperative biliary leakage in patients with perihilar cholangiocarcinoma

目的:分析肝门部胆管癌患者手术切除后胆漏的影响因素。方法:回顾分析2000年4月至2020年4月在宁波大学附属李惠利医院接受手术切除的179例肝门部胆管癌患者资料。最终纳入160例患者,其中男性86例,女性74例,年龄(63.4±10.8)岁。160例患者手术切除后发生B级胆漏44例、C级5例,均纳入胆漏组,剩余111例术后未发生胆漏的患者纳入对照组。单因素和多因素logistic回归分析肝门部胆管癌手术切除后胆漏的影响因素。结果:胆漏组手术时间≥360 min、保留侧肝门血管切除重建、残余肝断面胆管开口3支及以上等比例明显高于对照组,差异均有统计学意义(均P<0.05)。多因素logistic回归分析,保留侧肝门血管切除重建(OR=2.322,95%CI:1.078~5.002,P=0.028)、残余肝断面胆管开口3支及以上(OR=2.656,95%CI:1.198~5.892,P=0.016)的肝门部胆管癌患者手术切除后更易出现胆漏。结论:保留侧肝门血管切除重建、残余肝断面胆管开口3支及以上是肝门部胆管癌手术切除后胆漏的独立危险因素。

Objective To analyse the risk factors of biliary leakage after surgical resection in patients with perihilar cholangiocarcinoma(PHCC).Methods The medical data on 179 patients who underwent surgical resection for PHCC at the Department of Hepatopancreatobiliary Surgery,Ningbo Medical Centre Lihuili Hospital,Ningbo University from April 2000 to April 2020 were collected,and 160 patients were finally enrolled into this study.There were 86 males and 74 females,aged(63.4±10.8)years.The 44 patients with class B biliary leakage and the 5 patients with class C biliary leakage were classified into the biliary leakage group,while the remaining 111 patients were classified into the control group.Risk factors of biliary leakage were analysed by univariate and multivariate logistic regression analyses.Results Operation time≥360 min,resection and reconstruction of hepatic hilar vessels on the preserved side of liver and number of bile duct openings of>3 in remnant liver were significantly higher in the biliary leakage than the control group(all P<0.05).Multivariate analysis showed that resection and reconstruction of hepatic hilar vessels on the preserved side(OR=2.322,95%CI:1.078-5.002,P=0.028)and 3 or more bile duct openings in the remnant liver(OR=2.656,95%CI:1.198-5.892,P=0.016)were significantly associated with biliary leakage.Conclusion Resection and reconstruction of hepatic hilar vessels on the preserved side of liver and 3 or more bile duct openings in remnant liver were independent risk factors for biliary leakage after PHCC resection.