Analysis Of Causes And Treatment Of Biliary Leakage After Hepatobiliary Surgery

Objective To explore the causes and treatment decision of bile leakage after hepatobiliary surgery,and to provide clinical basis for diagnosis and treatment.Methods the clinical datas of 73 patients with biliary leakage after hepatobiliary surgery in General Sursery Clinical Center of Gansu Provincial people's Hospital from January 2010 to August 2018 were retrospectively analyzed,and according to the ways of operation,were divided into into observation group 1,2,3,4 and 5.The clinical data of 99 patients with no complications after hepatobiliary surgery were randomly selected according to the corresponding operation methods.and were divided into control group 1,2,3,4 and 5.and the treatment method was discussed.By comparing the observation groups with the control groups,the causes of bile leakage were compared and analyzed,and the treatment method was discussed.Results There were 32 cases in observation group 1(bile leakage after Laparoscopic Cholecystectomy),12 cases in observation group 2(bile leakage after removal of T tube),11 cases in observation group 3(laparoscopic choledocholithotomy and T-tube drainage / bile duct suture),11 cases in observation group 4(bile leakage after choledochojejunostomy)and 7 cases in observation group 5(bile leakage after partial hepatectomy).There was no significant difference in age,sex,BMI,and Child-Pugh grade of liver function between observation group1-5 and control group1-5(P > 0.05).The pre-operative levels of CRP,Hb and the number of days of hospitalization were statistically different in observation group 1 and control group1(P <0.01).The length of T tube and the number of days of hospitalization was significantly different in observation group 2 and control group 2(P < 0.05).There were no significant differences in ALB,TBIL,DBIL,Hb,WBC,NEUT% between observation group 2-5 and control group2-5(P > 0.05).On the premise of medical treatment(anti-inflammatory,octreotide or somatostatin,pain relief,acid inhibition,nutritional support,maintenance of electrolyte balance,etc.),in the treatment of 17 cases(23.3%)with simple abdominal drainage,13 cases were cured,and the cure rate was 72.5%.18 cases(24.7%)were treated with ultrasound-guided abdominal puncture and drainage,16 cases were cured,and the cure rate was 88.9%.15 cases(20.5%)were treated with double casing negative pressure flushing and drainage,15 cases were cured,the cure rate was 100%,15 cases(20.5%)were treated with abdominal double cannula negative pressure flushing and drainage,15 cases were cured,the curerate was 100%,8 cases(10.9%)were treated with PTCD and ultrasound-guided abdominal puncture and drainage,8 cases were cured,and the cure rate was 100%.1 cases(1.4%)were treated with ERCP,and the cure rate was 100%.4 cases(5.5%)were treated with ENBD,4 cases were cured,and the cure rate was 100%.10 cases(13.7%)with no improvement after 1 week of conservative treatment were treated with secondary operation,9 cases were cured,and the cure rate was 90%.Conclusion 1.The general conditions of the patients included sex,age,BMI,Child-Push grade of liver function are not the inevitable factor of bile leakage after hepatobiliary surgery,operation technique and perioperative management are directly related to bile leakage.2.Some laboratory examination results of patients with bile leakage were abnormal with the occurrence of complications of bile leakage,but they can not give clinical warning signal.3.ERCP,MRCP,PTCD drainage tube angiography,T tube angiography and drainage bile volume are effective methods to determine the location and severity of biliary leakage.4.it is safe and effective for the treatment of bile leakage with ultrasound-guided abdominal puncture,drainage therapy Double cannula,PTCD,ERCP,ENBD,etc.5.The occurrence of bile leakage is mainly due to subjective factors of surgical techniques,It is the key to reducing the incidence of bile leakage by finishing the review and evaluation of pre-operative medical history data,improving the surgical techniques,managing the operation carefully,discovering the biliary leakage as soon as possible,and treating in a timely manner.