Feng Jun,Wang Huanmin,Qin Hong,et al.Diagnosis and treatment of postoperative biliary fistula in children with hepatoblastoma[J].Journal of Clinical Pediatric Surgery,,19():794-799.[doi:10.3969/j.issn.1671-6353.2020.09.007]
Diagnosis and treatment of postoperative biliary fistula in children with hepatoblastoma
- CLC:
- R729;R735.7
- Abstract:
- Objective To summarize the experiences of diagnosing and treating postoperative biliary fistula in children with hepatoblastoma. Methods For 12 children with biliary fistula after hepatoblastoma surgery from May 2016 to March 2020,general profiles,clinical features,related imaging examinations,intraoperative findings,clinical manifestations,secondary complications and treatments were reviewed. Results Among 12 children with biliary fistula,there were 7 boys and 5 girls with a median onset age of 2(1-2.3) years.The tumors were primary (n=10) and recurrent (n=2).And 58.3% (n=7) of children were from PRETEXT Ⅲ-Ⅳ,66.7% (n=8) of tumors closely related to the first hepatic hilum and 91.7% (n=11) of tumors involving middle hepatic lobe.The median time of postoperative biliary fistula was 7(7-8.3) days and the median time of biliary fistula treatment 3.5(1.5-7.1) months.Biliary fistula might be diagnosed by detecting the concentration of bilirubin in abdominal drainage fluid,ultrasound-guided puncture,abdominal puncture or operation.The color of abdominal drainage deepened with a greater volume of biliary fistula.And 75% (n=9) were accompanied with encapsulated effusion and other complications included local infection (n=3),electrolyte disturbance (n=1),systemic infection (n=2),obstructive jaundice (n=1),greater liver hardness (n=1),biliary peritonitis (n=1) and intestinal obstruction (n=1).And 83.3% (n=10) could be cured by non-operative methods (simple abdominal drainage or ultrasound-guided puncture).16.7%(n=2) by biliary reconstruction surgery after non-operative treatment.The volume of abdominal drainage remained >100 ml and there were serious complications. Conclusion Biliary fistula often occurs in children with stage PRETEXT Ⅲ-Ⅳ and tumors involve middle hepatic lobe.The more hepatic lobes are involved,the closer operative site is to main biliary tract and the greater the possibility of postoperative biliary fistula.Biliary fistula often occurs at 1 week after operation.Bilirubin concentration of abdominal drainage fluid should be measured routinely.Children with encapsulated effusion after operation should be monitored regularly.Most cases of biliary fistula are not accompanied by serious complications.If drainage volume is <100 ml,non-operative treatment is a first choice; if drainage volume is >100 ml or serious complications occur after non-operative treatment,biliary tract reconstruction should be performed as soon as possible.
References:
1 Yang T,Whitlock RS,Vasudevan SA.Surgical management of hepatoblastoma and recent advances[J].Cancers (Basel),2019,11(12):E1944.DOI:10.3390/cancers11121944.
2 Brooke-Smith M,Figueras J,Ullah S,et al.Prospective evaluation of the International Study Group for Liver Surgery definition of bile leak after a liver resection and the role of routine operative drainage:an international multicentre study[J].HPB (Oxford),2015,17(1):46-51.DOI:10.1111/hpb.12322.
3 Koch M,Garden OJ,Padbury R,et al.Bile leakage after hepatobiliary and pancreatic surgery:a definition and grading of severity by the International Study Group of Liver Surgery[J].Surgery,2011,149(5):680-688.DOI:10.1016/j.surg.2010.12.002.
4 Zimmitti G,Roses RE,Andreou A,et al.Greater complexity of liver surgery is not associated with an increased incidence of liver-related complications except for bile leak:an experience with 2,628 consecutive resections[J].J Gastrointest Surg,2013,17(1):57-64.DOI:10.1007/s11605-012-2000-9.
5 Mohkam K,Farges O,Vibert E,et al.Risk score to predict biliary leakage after elective liver resection[J].Br J Surg,2018,105(1):128-139.DOI:10.1002/bjs.10647.
6 Sakamoto K,Tamesa T,Yukio T,et al.Risk factors and managements of bile leakage after hepatectomy[J].World J Surg,2016,40(1):182-189.DOI:10.1007/s00268-015-3156-8.
7 Braunwarth E,Primavesi F,G?bel G,et al.Is bile leakage after hepatic resection associated with impaired long-term survival?[J].Eur J Surg Oncol,2019,45(6):1077-1083.DOI:10.1016/j.ejso.2019.02.021.
8 Spetzler VN,Schepers M,Pinnschmidt HO,et al.The incidence and severity of post-hepatectomy bile leaks is affected by surgical indications,preoperative chemotherapy,and surgical procedures[J].Hepatobiliary Surg Nutr,2019,8(2):101-110.DOI:10.21037/hbsn.2019.02.06.
9 Roebuck DJ,Aronson D,Clapuyt P,et al.2005 PRETEXT:a revised staging system for primary malignant liver tumours of childhood developed by the SIOPEL group[J].Pediatr Radiol,2007,37(2):123-132.DOI:10.1007/s00247-006-0361-5.
10 Martin AN,Narayanan S,Turrentine FE,et al.Clinical factors and postoperative impact of bile leak after liver resection[J].J Gastrointest Surg,2018,22(4):661-667.DOI:10.1007/s11605-017-3650-4.
11 Maulat C,Regimbeau JM,Buc E,et al.Prevention of biliary fistula after partial hepatectomy by transcystic biliary drainage:randomized clinical trial[J].Br J Surg,2020,107(7):824-831.DOI:10.1002/bjs.11405.
12 Guillaud A,Pery C,Campillo B,et al.Incidence and predictive factors of clinically relevant bile leakage in the modern era of liver resections[J].HPB (Oxford),2013,15(3):224-229.DOI:10.1111/j.1477-2574.2012.00580.x.
13 Squires MH 3rd,Lad NL,Fisher SB,et al.Value of primary operative drain placement after major hepatectomy:a multi-institutional analysis of 1,041 patients[J].J Am Coll Surg,2015,220(4):396-402.DOI:10.1016/j.jamcollsurg.2014.12.029.
14 Nanashima A,Abo T,Shibuya A,et al.Does the placement of a cystic duct tube after a hepatic resection help reduce the incidence of post-operative bile leak?[J].HPB (Oxford),2013,15(7):517-522.DOI:10.1111/j.1477-2574.2012.00611.x.
15 Harimoto N,Muranushi R,Hoshino K,et al.Albumin-indocyanine green evaluation (ALICE) grade predicts bile leakage after hepatic resection[J].Surg Today,2020,50(8):849-854.DOI:10.1007/s00595-020-01955-2.
16 Nakano R,Ohira M,Kobayashi T,et al.Independent risk factors that predict bile leakage after hepatectomy for hepatocellular carcinoma:Cohort study[J].Int J Surg,2018,(57):1-7.DOI:10.1016/j.ijsu.2018.07.005.
17 Kubo N,Shirabe K.Treatment strategy for isolated bile leakage after hepatectomy:Literature review[J].Ann Gastroenterol Surg,2020,4(1):47-55.DOI:10.1002/ags3.12303.
18 Kimura T,Kawai T,Ohuchi Y,et al.Non-surgical management of bile leakage after hepatectomy:a single-center study[J].Yonago acta medica,2018,61(4):213-219.DOI:10.33160/yam.2018.12.004.
19 Murata R,Kamiizumi Y,Ishizuka C,et al.Anterograde bile duct drainage for intractable bile leakage after hepatectomy in a patient with previous pancreatoduodenectomy:A case report[J].Int J Surg Case Rep,2019,(55):121-124.DOI:10.1016/j.ijscr.2019.01.017.
20 Bressem KK,Erxleben C,Lauscher JC,et al.Successful CT-guided obliteration of isolated bile ducts with ethylene vinyl alcohol copolymer in a patient with chronic bile leakage after hepatectomy[J].J Vasc Interv Radiol,2019,30(10):1671-1673.DOI:10.1016/j.jvir.2019.05.020.
21 Kubo N,Harimoto N,Shibuya K,et al.Successful treatment of isolated bile leakage after hepatectomy combination therapy with percutaneous transhepatic portal embolization and bile duct ablation with ethanol:a case report[J].Surg Case Rep,2018,4(1):61.DOI:10.1186/s40792-018-0463-y.
22 Kannappan O,Keditsu K,Bhagat M,et al.Portal vein embolization for future liver remnant enhancement and combined modality treatment for the management of post-hepatic resection biliary fistula in an 18-month old child with hepatoblastoma[J].Front Surg,2019,(6):54.DOI:10.3389/fsurg.2019.00054.
23 Kada F,Abyad M,Contini S,et al.Fistulojejunostomy for refractory post-traumatic biliary fistula in an austere environment:an unusual,time-honored procedure[J].J Am Coll Surg,2015,220(5):e61-e63.DOI:10.1016/j.jamcollsurg.2015.01.022.
24 Viganò L,Ferrero A,Sgotto E,et al.Bile leak after hepatectomy:Predictive factors of spontaneous healing[J].Am J Surg,2008,196(2):195-200.DOI:10.1016/j.amjsurg.2007.08.062.
Memo
收稿日期:2020-04-13。
基金项目:中国工程院咨询研究课题（编号：2019—XY—34）
通讯作者:王焕民,Email:wanghuanmin@bch.com.cn