Background: Delayed bile leakage after laparoscopic cholecystectomy, defined as occurring more than 72 hours after surgery, is a rare and serious complication of laparoscopic cholecystectomy, with an incidence rate of...Background: Delayed bile leakage after laparoscopic cholecystectomy, defined as occurring more than 72 hours after surgery, is a rare and serious complication of laparoscopic cholecystectomy, with an incidence rate of 0.060%. Case Declaration: This case report details a patient diagnosed with delayed bile leakage 43 days after laparoscopic cholecystectomy. The patient was discharged from our hospital after undergoing CT-guided puncture treatment, with no obvious complications identified. The patient was monitored for one year following the procedure, during which time no significant discomfort was reported. Objective: This case report is to analyse and review the clinical manifestations, diagnosis, treatment and prevention of delayed bile leakage after cholecystectomy, with reference to the relevant literature. Results: Delayed bile leakage after laparoscopic cholecystectomy can be prevented, although not eliminated. It is recommended that the operator treat the operation with caution, avoid taking risks, and adhere to careful procedures and strict separation according to the requirements. This approach is key to preventing late bile leakage in the postoperative period.展开更多
AIM:To assess systematically the safety and efficacy of bile leakage test in liver resection.METHODS:Randomized controlled trials and controlled clinical trials involving the bile leakage test were included in a syste...AIM:To assess systematically the safety and efficacy of bile leakage test in liver resection.METHODS:Randomized controlled trials and controlled clinical trials involving the bile leakage test were included in a systematic literature search.Two authors independently assessed the studies for inclusion and extracted the data.A meta-analysis was conducted to estimate postoperative bile leakage,intraoperative positive bile leakage,and complications.We used either the fixed-effects or random-effects model.RESULTS:Eight studies involving a total of 1253 patients were included and they all involved the bile leakage test in liver resection.The bile leakage test group was associated with a significant reduction in bile leakage compared with the non-bile leakage test group(RR=0.39,95%CI:0.23-0.67;I2=3%).The white test had superiority for detection of intraoperative bile leakage compared with the saline solution test(RR=2.38,95%CI:1.24-4.56,P=0.009).No significant intergroup differences were observed in total number of complications,ileus,liver failure,intraperitoneal hemorrhage,pulmonary disorder,abdominal infection,and wound infection.CONCLUSION:The bile leakage test reduced postoperative bile leakage and did not increase incidence of complications.Fat emulsion is the best choice of solution for the test.展开更多
BACKGROUND： The primary focus of the study was to ana- lyze the risk factors for bile leakage after hepatectomy for be- nign or malignant tumors. METHODS： A total of 411 patients who had undergone hepa- tectomy betw...BACKGROUND： The primary focus of the study was to ana- lyze the risk factors for bile leakage after hepatectomy for be- nign or malignant tumors. METHODS： A total of 411 patients who had undergone hepa- tectomy between December 2006 and December 2011 were ret- rospectively analyzed. The severity of bile leakage was graded according to the ISGLS classification. Twenty-eight pre- and postoperative parameters were analyzed. RESULTS： The overall bile leakage incidence was 10.2% （42/411）. The severity of the leakage was classified according to the IS- GLS classification. Bile leakage was detected early in case of abdominal drainage （11.4% vs 1.9%, P=0.034）. It prolonged the time of hospitalization （16 vs 9 days, P=0.001）. In all patients, wedge resection was associated with a higher incidence of bile leakage in contrast to anatomical resections （25.6% vs 4.1%, P〈0.0001） regardless of the underlying liver disease. Furthermore, total vascular exclusion increased risk of bile leakage （P=0.008）. CONCLUSIONS： Bile leakage as a major issue after hepatic resection is related to the postoperative morbidity and the hospitalization time. It is associated with non-anatomical re- section and a total vascular exclusion.展开更多
We report a case of postoperative refractory bile leakage managed successfully by intrahepatic biliary ablation with ethanol. A 75-year-old man diagnosed with hepatocellular carcinoma underwent extended posterior segm...We report a case of postoperative refractory bile leakage managed successfully by intrahepatic biliary ablation with ethanol. A 75-year-old man diagnosed with hepatocellular carcinoma underwent extended posterior segmentectomy including the caudate lobe and a part of the anterior segment. The hepatic tumor attached to the anterior branch of the bile duct was detached carefully and resected. Fluid drained from the liver surface postoperatively contained high concentrations of total bilirubin, at a constant volume of 150 mL per day. On d 32 after surgery, a fistulogram of the drainage tube demonstrated an enhancement of the anterior bile duct. Endoscopic retrograde cholangiography demonstrated complete obstruction of the proximal anterior bile duct and no enhancement of the peripheral anterior bile duct. On d 46 after surgery, a retrograde transhepatic biliary drainage （RTBD） tube was inserted into the anterior bile duct under open surgery. However, a contrast study of RTBD taken 7 mo post-surgery revealed that the fistula remained patent despite prolonged conservative man- agement, so we decided to perform ethanol ablation of the isolated bile duct. Four mL pure ethanol was injected into the isolated anterior bile duct for ten minutes, the procedure being repeated five times a week. Following 23 attempts, the volume of bile juice reached less than 10 mL per day. The RTBD was clamped and removed two days later. After RTBD removal, the patient had no complaints or symptoms. Follow-up magnetic resonance imaging demonstrated atrophy of the ethanol-injected anterior segment without liver abscess formation.展开更多
In the current issue, Panaro et al presented a retro- spective single-center study on 411 hepatectomies for benign and malignant liver tumors. After exclusion of hilar cholangiocarcinomas and hepatectomies with simult...In the current issue, Panaro et al presented a retro- spective single-center study on 411 hepatectomies for benign and malignant liver tumors. After exclusion of hilar cholangiocarcinomas and hepatectomies with simultaneous biliary or pancreatic resection, risk factors for postoperative bile leakage were analyzed. Progress in preoperative assessment （e.g. modern imaging studies, liver function tests）, liver preconditioning （e.g. portal vein embolization）, improving perioperative care, and advances in surgical techniques （e.g. two stage hepatec- tomies, liver partition with portal vein ligation for staged hepatectomy） enable curative resections even for advanced hepatic malignancies with reasonable mortality rates and constantly improving oncological outcomes.展开更多
BACKGROUND; Operative complications after laparo- scopic cholecystectomy (LC) vary. Abdominal pain and other symptoms caused by fluid accumulation in the opera- tive area are not uncommon. Cystic duct (CD) leakage is ...BACKGROUND; Operative complications after laparo- scopic cholecystectomy (LC) vary. Abdominal pain and other symptoms caused by fluid accumulation in the opera- tive area are not uncommon. Cystic duct (CD) leakage is one of the main sources of the fluid. This study was to eva- luate the procedures used in the diagnosis and management of CD leakage after LC. METHOD: The clinical materials of 3 patients with CD leakage after LC were studied retrospectively. RESULTS: Three female patients underwent LC for chronic cholecystitis associated with stones. Their clinical symp- toms were worsened of pre-existed cardiac arrhythmia, bile draining out from drainage tube, and biliary spillage from umbilical incision, respectively. Final diagnosis was made at the 1st, 2nd and 20th post-operative day. Two of the 3 patients were treated laparoscopically. Their opened CD stumps were closed with an endo-loop, with the abdomen irrigated and drained. The other patient was drained with the percutaneous technique, and a biliary stent was inserted under endoscopy. All patients recovered well. CONCLUSIONS: The clinical manifestations of CD leakage are different. Ascites can be found by B-ultrasound. Final diagnosis is dependent on magnetic resonance cholangiog- raphy and/or endoscopic retrograde cholangiopancreatog- raphy. Minimally invasive techniques can be applied to this complication safely and effectively. Reoperarion for closure of the opened CD stump can be fulfilled under laparosco- py. Endoscopic drainage must be accompanied with effec- tive abdominal drainage.展开更多
BACKGROUND:Cholecystectomy is the most commonly performed procedure in general surgery.However,bile duct injury is a rare but still one of the most common complications.These injuries sometimes present variably after ...BACKGROUND:Cholecystectomy is the most commonly performed procedure in general surgery.However,bile duct injury is a rare but still one of the most common complications.These injuries sometimes present variably after primary surgery.Timely detection and appropriate management decrease the morbidity and mortality of the operation. METHODS:Five cases of iatrogenic bile duct injury(IBDI) were managed at the Department of Surgery,First Affiliated Hospital,Xi’an Jiaotong University.All the cases who underwent both open and laparoscopic cholecystectomy had persistent injury to the biliary tract and were treated accordingly. RESULTS:Recovery of the patients was uneventful.All patients were followed-up at the surgical outpatient department for six months to three years.So far the patients have shown good recovery. CONCLUSIONS:In cases of IBDI it is necessary to perform the operation under the supervision of an experienced surgeon who is specialized in the repair of bile duct injuries,and it is also necessary to detect and treat the injury as soon as possible to obtain a satisfactory outcome.展开更多
目的探讨腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)后拔除T管出现胆漏的诊治。方法回顾性分析我院2016年7月至2021年12月实施的LCBDE共1062例,其中919例留置T管,术后T管拔除时间为43~102 d,平均拔除时间82...目的探讨腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)后拔除T管出现胆漏的诊治。方法回顾性分析我院2016年7月至2021年12月实施的LCBDE共1062例,其中919例留置T管,术后T管拔除时间为43~102 d,平均拔除时间82 d,拔除T管后9例(0.9%)出现胆漏,分析归纳9例患者的临床资料。结果5例经窦道放置引流管,2例经窦道放置引流管联合腹腔穿刺引流,1例经窦道放置引流管并行腹腔穿刺引流联合内窥镜鼻胆管引流(endoscopic nasobiliary drainage,ENBD)引流;1例经窦道放置引流管联合ENBD引流,9例患者均治愈,平均住院天数22 d。结论LCBDE后拔除T管出现胆漏不能完全避免,且原因复杂,发生胆漏后可采用微创治疗,如放置窦道引流管、B超引导下腹腔穿刺引流、ENBD等,效果满意。展开更多
文摘Background: Delayed bile leakage after laparoscopic cholecystectomy, defined as occurring more than 72 hours after surgery, is a rare and serious complication of laparoscopic cholecystectomy, with an incidence rate of 0.060%. Case Declaration: This case report details a patient diagnosed with delayed bile leakage 43 days after laparoscopic cholecystectomy. The patient was discharged from our hospital after undergoing CT-guided puncture treatment, with no obvious complications identified. The patient was monitored for one year following the procedure, during which time no significant discomfort was reported. Objective: This case report is to analyse and review the clinical manifestations, diagnosis, treatment and prevention of delayed bile leakage after cholecystectomy, with reference to the relevant literature. Results: Delayed bile leakage after laparoscopic cholecystectomy can be prevented, although not eliminated. It is recommended that the operator treat the operation with caution, avoid taking risks, and adhere to careful procedures and strict separation according to the requirements. This approach is key to preventing late bile leakage in the postoperative period.
基金Supported by National Science and Technology Major Project of ChinaNo.2012ZX10002-016 and No.2012ZX10002-017
文摘AIM:To assess systematically the safety and efficacy of bile leakage test in liver resection.METHODS:Randomized controlled trials and controlled clinical trials involving the bile leakage test were included in a systematic literature search.Two authors independently assessed the studies for inclusion and extracted the data.A meta-analysis was conducted to estimate postoperative bile leakage,intraoperative positive bile leakage,and complications.We used either the fixed-effects or random-effects model.RESULTS:Eight studies involving a total of 1253 patients were included and they all involved the bile leakage test in liver resection.The bile leakage test group was associated with a significant reduction in bile leakage compared with the non-bile leakage test group(RR=0.39,95%CI:0.23-0.67;I2=3%).The white test had superiority for detection of intraoperative bile leakage compared with the saline solution test(RR=2.38,95%CI:1.24-4.56,P=0.009).No significant intergroup differences were observed in total number of complications,ileus,liver failure,intraperitoneal hemorrhage,pulmonary disorder,abdominal infection,and wound infection.CONCLUSION:The bile leakage test reduced postoperative bile leakage and did not increase incidence of complications.Fat emulsion is the best choice of solution for the test.
文摘BACKGROUND： The primary focus of the study was to ana- lyze the risk factors for bile leakage after hepatectomy for be- nign or malignant tumors. METHODS： A total of 411 patients who had undergone hepa- tectomy between December 2006 and December 2011 were ret- rospectively analyzed. The severity of bile leakage was graded according to the ISGLS classification. Twenty-eight pre- and postoperative parameters were analyzed. RESULTS： The overall bile leakage incidence was 10.2% （42/411）. The severity of the leakage was classified according to the IS- GLS classification. Bile leakage was detected early in case of abdominal drainage （11.4% vs 1.9%, P=0.034）. It prolonged the time of hospitalization （16 vs 9 days, P=0.001）. In all patients, wedge resection was associated with a higher incidence of bile leakage in contrast to anatomical resections （25.6% vs 4.1%, P〈0.0001） regardless of the underlying liver disease. Furthermore, total vascular exclusion increased risk of bile leakage （P=0.008）. CONCLUSIONS： Bile leakage as a major issue after hepatic resection is related to the postoperative morbidity and the hospitalization time. It is associated with non-anatomical re- section and a total vascular exclusion.
文摘We report a case of postoperative refractory bile leakage managed successfully by intrahepatic biliary ablation with ethanol. A 75-year-old man diagnosed with hepatocellular carcinoma underwent extended posterior segmentectomy including the caudate lobe and a part of the anterior segment. The hepatic tumor attached to the anterior branch of the bile duct was detached carefully and resected. Fluid drained from the liver surface postoperatively contained high concentrations of total bilirubin, at a constant volume of 150 mL per day. On d 32 after surgery, a fistulogram of the drainage tube demonstrated an enhancement of the anterior bile duct. Endoscopic retrograde cholangiography demonstrated complete obstruction of the proximal anterior bile duct and no enhancement of the peripheral anterior bile duct. On d 46 after surgery, a retrograde transhepatic biliary drainage （RTBD） tube was inserted into the anterior bile duct under open surgery. However, a contrast study of RTBD taken 7 mo post-surgery revealed that the fistula remained patent despite prolonged conservative man- agement, so we decided to perform ethanol ablation of the isolated bile duct. Four mL pure ethanol was injected into the isolated anterior bile duct for ten minutes, the procedure being repeated five times a week. Following 23 attempts, the volume of bile juice reached less than 10 mL per day. The RTBD was clamped and removed two days later. After RTBD removal, the patient had no complaints or symptoms. Follow-up magnetic resonance imaging demonstrated atrophy of the ethanol-injected anterior segment without liver abscess formation.
文摘In the current issue, Panaro et al presented a retro- spective single-center study on 411 hepatectomies for benign and malignant liver tumors. After exclusion of hilar cholangiocarcinomas and hepatectomies with simultaneous biliary or pancreatic resection, risk factors for postoperative bile leakage were analyzed. Progress in preoperative assessment （e.g. modern imaging studies, liver function tests）, liver preconditioning （e.g. portal vein embolization）, improving perioperative care, and advances in surgical techniques （e.g. two stage hepatec- tomies, liver partition with portal vein ligation for staged hepatectomy） enable curative resections even for advanced hepatic malignancies with reasonable mortality rates and constantly improving oncological outcomes.
文摘BACKGROUND; Operative complications after laparo- scopic cholecystectomy (LC) vary. Abdominal pain and other symptoms caused by fluid accumulation in the opera- tive area are not uncommon. Cystic duct (CD) leakage is one of the main sources of the fluid. This study was to eva- luate the procedures used in the diagnosis and management of CD leakage after LC. METHOD: The clinical materials of 3 patients with CD leakage after LC were studied retrospectively. RESULTS: Three female patients underwent LC for chronic cholecystitis associated with stones. Their clinical symp- toms were worsened of pre-existed cardiac arrhythmia, bile draining out from drainage tube, and biliary spillage from umbilical incision, respectively. Final diagnosis was made at the 1st, 2nd and 20th post-operative day. Two of the 3 patients were treated laparoscopically. Their opened CD stumps were closed with an endo-loop, with the abdomen irrigated and drained. The other patient was drained with the percutaneous technique, and a biliary stent was inserted under endoscopy. All patients recovered well. CONCLUSIONS: The clinical manifestations of CD leakage are different. Ascites can be found by B-ultrasound. Final diagnosis is dependent on magnetic resonance cholangiog- raphy and/or endoscopic retrograde cholangiopancreatog- raphy. Minimally invasive techniques can be applied to this complication safely and effectively. Reoperarion for closure of the opened CD stump can be fulfilled under laparosco- py. Endoscopic drainage must be accompanied with effec- tive abdominal drainage.
文摘BACKGROUND:Cholecystectomy is the most commonly performed procedure in general surgery.However,bile duct injury is a rare but still one of the most common complications.These injuries sometimes present variably after primary surgery.Timely detection and appropriate management decrease the morbidity and mortality of the operation. METHODS:Five cases of iatrogenic bile duct injury(IBDI) were managed at the Department of Surgery,First Affiliated Hospital,Xi’an Jiaotong University.All the cases who underwent both open and laparoscopic cholecystectomy had persistent injury to the biliary tract and were treated accordingly. RESULTS:Recovery of the patients was uneventful.All patients were followed-up at the surgical outpatient department for six months to three years.So far the patients have shown good recovery. CONCLUSIONS:In cases of IBDI it is necessary to perform the operation under the supervision of an experienced surgeon who is specialized in the repair of bile duct injuries,and it is also necessary to detect and treat the injury as soon as possible to obtain a satisfactory outcome.
文摘目的探讨腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)后拔除T管出现胆漏的诊治。方法回顾性分析我院2016年7月至2021年12月实施的LCBDE共1062例,其中919例留置T管,术后T管拔除时间为43~102 d,平均拔除时间82 d,拔除T管后9例(0.9%)出现胆漏,分析归纳9例患者的临床资料。结果5例经窦道放置引流管,2例经窦道放置引流管联合腹腔穿刺引流,1例经窦道放置引流管并行腹腔穿刺引流联合内窥镜鼻胆管引流(endoscopic nasobiliary drainage,ENBD)引流;1例经窦道放置引流管联合ENBD引流,9例患者均治愈,平均住院天数22 d。结论LCBDE后拔除T管出现胆漏不能完全避免,且原因复杂,发生胆漏后可采用微创治疗,如放置窦道引流管、B超引导下腹腔穿刺引流、ENBD等,效果满意。
