ObjectiveTo investigate the clinical significances of intraoperative methylene blue diluent injection through the residual bile duct for bile leakage after hepatic hydatidosis surgery.MethodsThe patients with hepatic hydatidosis who received the surgical treatment in this hospital from December 2018 to November 2019 were randomly divided into a study group and control group. The patients in the study group received the treatment of anatomical or nonanatomical hepatic lobectomy. The first hepatic hilum was locked, then the methylene blue diluent was injected through the residual bile duct to find the bile leakage. The drainage tube was retained in the abdominal cavity after the surgery. The patients in the control group except the white gauze was used to compress the liver wound surface for 5 min to find the bile leakage, the other treatment process was the same as the study group. The operation time, intraoperative blood loss, liver function on day 3 after the surgery (total bilirubin, alanine aminotransferase, albumin), detection rate of bile leakage during operation, postoperative complications (pulmonary infection, ascites, incision infection, bile leakage, residual cavity infection, and electrolyte disturbance), postoperative hospitalization time, and total hospitalization cost were compared between two groups.ResultsAccording to the inclusion and exclusion criteria, 67 patients were included in this study, including 32 in the study group and 35 in the control group. There were no significant differences in the baseline data such as the age, gender, preoperative complications, preoperative liver function (total bilirubin, alanine aminotransferase, albumin), and liver hydatid classification between the two groups (P>0.05). The operations were successful in the 67 patients, no perioperative death occurred. The detection rate of bile leakage during operation in the study group was higher than that in the control group (53.1% versus 17.1%, P<0.05). The postoperative hospitalization time was shorter and the total hospitalization cost was lower in the study group as compared with the control group (P<0.05). There were no significant differences in the operation time, intraoperative blood loss, liver function on day 3 after the surgery between the two groups (P>0.05). There was no case of the incision infection, bile leakage, and residual cavity infection in the study group, but there were 1, 5 and 4 cases in the control group, respectively. The incidences of incision infection and bile leakage had statistical significances between the two groups (P<0.05), and there was no significant differences in the incidences of other complications between the two groups (P>0.05).ConclusionsDetection rate of bile leakage during operation is high by intraoperative methylene blue diluent injection through the residual bile duct for bile leakage after hepatic hydatidosis surgery. It could reduce bile leakage, shorten postoperative hospitalization time, and reduce total hospitalization cost.
ObjectiveTo evaluate the safety and efficacy of unconventional abdominal drainage after laparoscopic hepatectomy.MethodsThe clinicopathologic data of patients who underwent laparoscopic hepatectomy for liver tumors in the Mianyang Central Hospital from June to December 2019 and met the inclusion criteria were retrospectively collected. Based on whether drainage tube was placed in the abdominal cavity during operation, the patients were divided into non-catheterized group (without drainage tube) and catheterized group (with drainage tube). The intraoperative data and postoperative complications (e.g. intraabdominal hemorrhage, bile leakage, abdominal infection, and liver failure) were compared between the two groups. Then, the intraoperative data and postoperative conditions of liver cancer and non-liver cancer patients with or without abdominal drainage tube were compared and analyzed.ResultsA total of 117 eligible patients were included in the study. The non-catheterized group had 59 patients and the catheterized group had 58 patients. The patients with liver cancer had 84 patients (44 non-catheterized patients and 40 catheterized patients) and the patients without liver cancer had 33 patients (15 non-catheterized patients and 18 catheterized patients). ① On the whole, the groups were comparable in the baseline data between the non-catheterized group and the catheterized group, such as gender, age, HBV infection, body mass index, hepatic function index, liver stiffness value, disease category, etc. (P>0.05). Compared with the catheterized group, the non-catheterized group had earlier off-bed activities and earlier flatus time (P<0.001), and shorter postoperative hospital stay (P=0.030). However, no statistically significant differences were found in other indicators between the two groups (P>0.05). ② Whether the patients had liver cancer or not, the non-catheterized patients still had earlier off-bed activities and earlier flatus time as compared with the catheterized patients (P<0.001). Among the patients with liver cancer, no difference was found in postoperative hospital stay. However, among the patients without liver cancer, the non-catheterized patients had shorter postoperative hospital stay than the catheterized patients (P=0.042). No statistically significant differences were found in other indicators between the catheterized patients and non-catheterized patients (P>0.05).ConclusionFor technologically skilled laparoscopic hepatectomy center, selectively not placing peritoneal drainage tube after surgery might better promote the health of patients.
Bile leakage is a common complication of hepatocellular carcinoma (HCC) after hepatectomy, which affects the prognosis and medical quality. It is emphasized that taking preventive measures according to the etiology and related risk factors could help to reduce the incidence of bile leakage, improve the quality and safety of HCC diagnosis and treatment, and achieve the main indicators of HCC quality control in the 2022 version of National Cancer Center. In this review, combined with the team of Peng’s leakage test technology research and clinical practice, brief talk about personal experience.