The Application Of External Biliary Drainage In Serious Liver Injury

Objective: Research on the application of external biliary drainage in seriousliver injury.Methods: Retrospective analysis of42patients with serious liver injury from June2002to June2011at Dalian Medical University1st&2ndAffiliated hospital. Theadmitted patients were all categorized according to the American Association for theSurgery of Trauma (AAST) liver injury classification&they all belonged to class III&above.42cases were divided into2groups, the1stgroup of11cases were placed with aexternal biliary drainage&the2ndgroup of31cases were without any external biliarydrainage. Two groups were compared in age, gender, AAST classification, operativetime, blood loss, intraoperative transfusion (blood transfusion+fluid transfusion),length of stay, infection control time (blood parameters return to normal), postoperativecomplications, postoperative bile leakage&differences in liver function recovery time.Results:1. The two groups in age, P=0.931>0.05, was not statistically significant. Twogroups of patients had no significant difference in age, the average age（(?)±s）of theexternal biliary drainage group was33.73±16.67years, the average age（(?)±s）of the nonexternal biliary drainage group was33.35±10.23years, the overall average age（(?)±s）was33.45±12.01years dominated by young or middle age.2. The two groups in gender, P=0.009<0.05, was statistically significant. Twogroups of patients had significant difference in gender. Males in the external biliarydrainage group was54.55%, Males in the non external biliary drainage group was90.32%. Overall males accounted for80.95%. Males significantly more than females.3. The two groups in AAST classification, P=0.096>0.05, was not statisticallysignificant. Two groups of patients had no significant difference in AAST classification. Overall Class III accounted for57.14%, Class IV accounted for23.81%，Class Vaccounted for11.90%, Class VI accounted for7.14%.So Class III&IV patients were inthe majority, the Class V&VI patients were in the minority. Not place the externaldrainage group accounted for67.74%of Class III and19.35%of Class IV. Placed theexternal drainage group accounting for27.27%of Class III and36.36%of Class IV.Therefore patients placed the external biliary drainage group with mainly Clss IV liverinjury, but patients not placed the external biliary drainage group with mainly Class IIIliver injury.4. The two groups in operative time, P=0.004<0.05, was statistically significant.Two groups of patients had significant difference in operative time. The averageoperative time（(?)±s）of the external biliary drainage group was244.09±88.76mins;the average operative time（(?)±s）of the non external biliary drainage group was155.97±80.40mins, The operative time of external biliary drainage group wassignificantly longer than non external biliary drainage group.5. The two groups in the amount of intraoperative blood loss, P=0.956>0.05,was not statistically significant. Two groups of patients had no significant difference inintraoperative blood loss. The average intraoperative blood loss（(?)±s）of the externalbiliary drainage group was2446.46±1037.65ml, the average intraoperative blood loss（(?)±s）of the non the external biliary drainage group was2470.97±1886.65ml. Theoverall average intraoperative blood loss（(?)±s）was2464.29±1693.29ml.6. The two groups in the amount of transfusion (blood transfusion+fluidtransfusion), P=0.775>0.05, was not statistically significant. Two groups of patientshad no significant difference in the amount of fluid transfused. The average amount offluid transfuse（d(?)±s）for the external biliary drainage group was4723.64±2215.58ml,the average amount of fluid transfused（(?)±s）for the non external biliary drainagegroup was4458.07±2757.87ml, the overall average amount of fluid transfused（(?)±s）was4527.62±2603.17ml.7. The two groups in hospitalization time, P=0.046<0.05, was statisticallysignificant.Two groups of patients had significant difference in hospitalization time.The average hospitalization time（(?)±s）of the external biliary drainage group was45.45±38.45days, the average hospitalization time（(?)±s）of the non external biliarydrainage group was18.94±8.90days. The hospitalization time of external biliarydrainage group was significantly longer than non external biliary drainage group.8. The two groups in infection control time (the time of blood parameters return to normal), P=0.001<0.05, was statistically significant.Two groups of patients hadsignificant difference in infection control time. The average infection control time（(?)±s）of the external biliary drainage group was14.73±6.07days, the average infectioncontrol time（(?)±s）of the non external biliary drainage group was7.29±4.37days. Theinfection control time of external biliary drainage group was significantly longer thannon external biliary drainage group.9. The two groups in postoperative complications, P=0.036<0.05, wasstatistically significant. Two groups of patients had significant difference inpostoperative complications. Postoperative complications in the external biliarydrainage group was81.82%, Postoperative complications in the non external biliarydrainage group was45.16%. The percentage of postoperative complications in externalbiliary drainage group was significantly higher than non external biliary drainagegroup.10. The two groups in postoperative bile leakage, P=0.047<0.05, was statisticallysignificant.Two groups of patients had significant difference in bile leakage.Postoperative bile leakage in the external biliary drainage group was9.09%.Postoperative bile leakage in the non external biliary drainage group was41.74%.The percentage of postoperative bile leakage in external biliary drainage group wassignificantly lower than non external biliary drainage group.11. The two groups in liver function recovery time, P=0.024<0.05, wasstatistically significant.Two groups of patients had significant difference in liverfunction recovery time. The average liver function returned time（(?)±s）of the externalbiliary drainage group was12.18±3.25days, the average liver function returned time（(?)±s）of the non external biliary drainage group was16.55±8.83days. The liver functionrecovery time of external biliary drainage group was significantly shorter than nonexternal biliary drainage group.Conclusion:1. Serious liver injury dominated by young or middle age.2. Males significantly more than females in the serious liver injury.3. Patients with serious liver injury, Class III&IV patients were in the majority,Class V&VI patients were in the minority. Patients placed the external biliary drainagegroup with mainly Clss IV liver injury, but patients not placed the external biliarydrainage group with mainly Class III liver injury.4. In operative time, the external biliary drainage group was significantly longer than non external biliary drainage group.5. In intraoperative blood loss, the external biliary drainage group and the nonexternal biliary drainage group had no statistical significance.6. In the amount of transfusion (blood transfusion+transfusion), the externalbiliary drainage group and the non external biliary drainage group had no statisticalsignificance.7. In hospitalization time, the external biliary drainage group was significantlylonger than non external biliary drainage group.8. In infection control time (the time of blood parameters return to normal), theexternal biliary drainage group was significantly longer than non external biliarydrainage group.9. In postoperative complications, the percentage of postoperative complicationsin external biliary drainage group was significantly higher than non external biliarydrainage group.10. In postoperative bile leakage, the percentage of postoperative bile leakage inexternal biliary drainage group was significantly lower than non external biliarydrainage group.11.In liver function recovery time, the external biliary drainage group wassignificantly shorter than non external biliary drainage group.Therefore, patients with serious liver injury, especially above the Class IV shouldbe placed external biliary drainage.