Comparison Of The Effect Of The Application Of The Methylene Blue Test And The Normal Saline Test In The Prevention Of Postoperative Biliary Fistula In The Sub-total Cystectomy Of Hepatic Cystic Echinococcosis

Objective:Bile fistula is the most common complication after liver hydatid surgery(8.2-26%).The purpose of our research is to compare the effects of normal saline and melanin during the operation on the prevention of biliary fistula after extracapsular subtotal cystectomy.Methods:219 patients with hepatic cystic echinococcosis were divided into methylene blue test group and normal saline test group according to different methods of bile leakage detection.Among them,167 cases of patients with intraoperative methylene blue staining test detection;52 cases of patients with intraoperative saline test.In both groups,the visible bile duct stumps in the operation area were sutured,and drainage tubes were placed in all operation areas.Record the number of bile duct stumps and postoperative drainage through the drainage tube.The two groups of patients also compared the number of days the drainage tube was placed,the length of hospital stay,and the secondary interventions related to biliary complications.Results:Intraoperative biliary fistula was more likely to be detected in the methylene blue experimental group by51.1%,which was significantly higher than the incidence of 29.6%in the water injection trial group(χ~2=8.187,P<0.05);The complication rate of patients with intraoperative use of the methylene blue experimental group was 4.2%,significantly lower than 17.3%in the water injection test group(χ~2=10.073,P<0.05).The average postoperative drainage time and postoperative hospital stay of the methylene blue experimental group were(5.1±1.7)days and(6.1±1.7)days,respectively,which were significantly lower than those of the water injection test group(6.2±2.9)days and(7.3±3.0)days(t=-2.693,t=-2.788,P<0.05).There were no patients in the two group who needed postoperative endoscopic retrograde cholangiopancreatography(ERCP)or nasobiliary drainage.And there were no long-term biliary complications in both groups after 3 years of follow-up.Conclusion:Compared with the use of normal saline to check the bile leakage during the operation,the methylene blue test is easier to determine the location of the bile leakage during the operation and the ligation of the bile duct stump can further reduce the biliary complications after sub-total cystectomy of hepatic cystic echinococcosis.