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Факторы риска развития билиарных осложнений после резекции печени

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Цель работы – выявление факторов риска развития желчеистечения. Проведенное ретроспективное исследование включало 279 резекций печени. Анализу подвергли 26 предоперационных и интраоперационных факторов. Послеоперационная летальность и частота послеоперационных осложнений составили 1 и 35,8%. Билиарные осложнения развились у 18,6% пациентов. Желчеистечение не сопровождалось увеличением летальности и частоты печеночной недостаточности. Консервативная тактика и миниинвазивные мероприятия оказались эффективны в большинстве наблюдений (90,5%). Выявлен фактор риска развития желчных осложнений: внепеченочное пересечение долевого протока при правосторонней гемигепатэктомии.

Ключевые слова:
резекция печени, желчеистечение, билиарные осложнения.

Литература:
1. Belghiti J., Hiramatsu K., Benoist S. et al. Seven hundred fortyseven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection // J. Am. Coll. Surg. 2000. V. 191. №1. P. 38–46.
2. Jarnagin W.R., Gonen M., Fong Y. et al. Improvement in perioperative outcome after hepatic resection // Ann. Surg. 2002. V. 236. №4. P. 397–407.
3. Imamura H., Seyama Y., Kokudo N. et al. One thousand fifty-six epatectomies without mortality in 8 years // Arch. Surg. 2003.
V. 138. P. 1198–1206.
4. Kondo K., Chijiiwa K., Funagayama M. et al. Hepatic resection is
justified for elderly patients with hepatocellular carcinoma // Wld J. Surg. 2008. V. 32. P. 2223–2229.
5. Cescon M., Vetrone G., Grazi G.L. et al. Trends in Perioperative
outcome after hepatic rsection. Analysis of 1500 consecutive unselected cases over 20 years // Ann. Surg. 2009. V. 249. P. 995–1002.
6. Erdogan D., Busch O.R.C., Gouma D.J. et al. Prevention of biliary
leakage after partial liver resection using topical hemostatic agents // Dig. Surg. 2007. V. 24. P. 294–299.
7. Reed D.N., Vitale G.C., Wrightson W.R. et al. Decreasing mortality of bile leaks after elective hepatic surgery // Am. J. Surg. 2003. V. 185. P. 316–318.
8. Lo C.4M., Fan S.4T., Liu C.4L. et al. Biliary complications after
hepatic resection // Arch. Surg. 1998. V. 133. P. 156–161.
9. Tanaka S., Hirohashi K., Tanaka H. et al. Incidence and management of bile leakage after hepatic resection for malignant hepatic tumors // J. Am. Coll. Surg. 2002. V. 195. № 4. P. 484–489.
10. Erdogan D., Busch O.R.C., van Delden O.M. et al. Incidence and
management of bile leakage after partial liver resection // Dig. Surg. 2008. V. 25. P. 60–66.
11. Lam C.4M., Lo C.4M., Liu C.4L. Biliary complications during liver resection // Wld J. Surg. 2001. V. 25. P. 1273–1276.
12. Nagano Y., Togo S., Tanaka K. et al. Risk factors and management of bile leakage after hepatic resection // Wld J. Surg. 2003. V. 27. P. 695–698.
13. Ijichi M., Takayama T., Toyoda H. et al. Randomized trial of the
Usefulness of a bile leakage test during hepatic resection // Arch Surg. 2000. V. 135. P. 1395–1400.
14. Yamashita Y., Hamatsu T., Rikimaru T. et al. Bile leakage after
hepatic resection // Ann. Surg. 2000. V. 233. N. 1. P. 45–50.
15. Capussotti L., Ferrero A., Vigano L. et al. Bile leakage and liver
resection. Where is the risk? // Arch. Surg. 2006. V. 141. P. 690–694.
16. Sun H.4C., Qin L.4X., Wang L. et al. Risk factors for postoperative complications after liver resection // Hepatobiliary Pancreat Dis Int. 2005. V. 4. P. 370–374.
17. Патютко Ю.И., Сагайдак И.В., Чучуев Е.С. и др. Хирургическое лечение первичного рака печени // Практ. онкол. 2008. Т. 9. № 4. С. 197–201.
18. Dinant S., Gerhards M.F., Rauws E.A.J. et al. Improved outcome
of resection of hilar cholangiocarcinoma (Klatskin tumor) // Ann. Surg. Oncol. 2006. V. 13. N. 6. P. 872–880.
19. Li S.4Q., Liang L.4J., Peng B.4G. et al. Bile leakage after hepatectomy for hepatolithiasis: risk factors and management // Surg. 2007. V. 141. P. 3405.
20. Okabayashi T., Nishimori I., Yamashita K. et al. Risk factors and
predictors for surgical site infection after hepatic resection // J. ospital Infection. 2009. V. 73. P. 47–53.
21. Strasberg S.M. Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system // J. Hepatobiliary Pancreat Surg. 2005. V. 12. P. 351–355.
22. Smyrniotis V., Arkadopoulos N., Theodoraki K. et al. Association between biliary complications and technique of hilar division (extrahepatic vs. intrahepatic) in major liver resections // Wld J. Surg. Oncol. 2006. V. 4. P. 59–66.
23. Matthews J.B., Gertsch P., Baer H.U. et al. Biliary stricture following hepatic resection // H.P.B. Surg. 1991. V. 3. P. 181–191.
24. Tekin A., Perek S. Biliary stricture due to hypertrophied liver
rotation after right hepatic lobectomy // Dig Surg. 2000. V. 17. №4. P. 395–398.
25. Hasegawa K., Yazumi S., Egawa H. et al. Endoscopic management of postoperative biliary complications in donors for living donor liver transplantation // Clin. Gastroenterol. Hepatol. 2003. V. 1. P. 183–188.
26. Rose D.M., Rose A.T., Chapman W.C. et al. Management of bronchobiliary fistula as a late complication of hepatic resection // Am. Surg. 1998. V. 64. № 9. P. 873–876.
27. Figueras J., Llado L., Miro M. et al. Application of fibrin glue sealants after hepatectomy does not seem justified. Results of a randomized study in 300 patients // Ann. Surg. 2007. V. 245. P. 536–542.
28. Бунатян А.Г., Завенян З.С., Багмет Н.Н. и др. Проблемы гемостаза и герметизма при резекциях печени с использованием фибрин-коллагеновой субстанции // Хирургия. 2003. №9. С. 18–23.
29. Poon R.T.P. Current techniques of liver transaction // H.P.B.
2007. V. 9. P. 166-173.
30. Mizumoto R., Suzuki H. Surgical anatomy of the hepatic hilum
with special reference to the caudate lobe // World J. Surg. 1988. V. 12. P. 2–10.

Bile Leakage Risk Factors after the Liver Resection

The aim of this study was to identify risk factors of bile leakage. This retrospective study includes 279 consecutive cases of the patients that underwent hepatectomy. 26 preoperative and intraoperative factors were analyzed. Postoperative mortality and morbidity rates came to 1% and 35.8% respectively. Bile leakage developed in 18.6%. It was associated with higher mortality and liver failure rates. Conservative and minimally invasive management appeared successful in most of cases (90,5%). Extrahepatic transection of lobar duct during right hemihepatectomy is revealed as a risk factor of biliary leakage.

Keywords:
liver resection, bile leakage, biliary complications.