The Application Of Intraoperative Methylene Blue Test In Reducing The Incidence Of Postoperative Bile Leakage Complication After Hepatectomy-a Study Of107Cases Of Hepatectomies From First Affiliated Hospital Of Guangxi Medical University

Aim： To explore the applicability of intraoperative methylene blue test inreducing the incidence of post operative bile leakage complication after hepaticresection based on the analysis of clinical data of107cases of hepatectomypatients from First Affiliated Hospital of Guangxi Medical University. Methods:A retrospective study of a total of107cases of hepatectomies patients whichincluded38patients who underwent intraoperative modified methylene blue test(MT) as study group and69patients without test as control group from January2013to January2014. The incidence and severity of post operative bile leakagewere then analyzed. Factors with P≤0.5in univariate analysis was subjected tobinary logistic regression analysis between bile leakage group and no leakage group. The patient with recurrent hepatocellular carcinoma and underwentbiliary reconstruction were excluded from the analysis. Results: Among107hepatectomies, postoperative bile leakage occurred in3of38patients in MTgroup and7of69patients in control group. The incidence of bile leakage was7.9%(MT) and10.1%(control) with x2=0.146, P=0.497. We compared thepostoperative drainage total bilirubin concentration and drainage total bilirubinamount in the first, second and third postoperative day and found that thedifference was not statistically significant (P>0.05). The severity of all10bileleakage patients are grade A and all bile leakage relieved spontaneously underconservative treatment. Multivariate analysis suggested that prolonged operationtime was a risk for postoperative biliary complications (P=0.008, OR=1.018(1.005-1.031)) and intraoperative modified methylene blue test has an efficacyon reducing the postoperative biliary complications with (P=0.012, OR=0.031(0.002-0.464)). Conclusion: Prolonged operation time was an independent riskfactor for bile leakage. For the patient with postoperative hypoalbuminemia, weshould actively improve their nutritional status, in order to prevent thepostoperative complications. Although intraoperative bile leakage test cannot beeradicated the postoperative bile leakage complications, but it seems to reducethe incidence.