肝胆胰外科术后胆漏：肝脏外科的国际研究小组的定义和严重程度分级

肝胆胰外科术后胆漏：肝脏外科的国际研究小组的定义和严重程度分级

摘要

背景：

尽管潜在的严重影响患者的围手术期和长期的结果，这种肝胆胰手术后并发胆漏常用的定义尚未建立。本文的目的是提出一个关于肝胆胰手术治疗后胆漏的统一的定义和严重性分级。

方法：

一个肝胆胰外科医生的国际研究小组的召开。在肝胆胰手术治疗后胆汁泄漏患者的血清和排出液体中胆红素浓度的基础上开发的一个共识的定义。

结果：

根据评价接受肝胆胰手术后胆漏患者排出液中的胆红素水平，肝胆胰手术治疗后胆漏被定义为胆红素排出液体的浓度至少为血清胆红素浓度3倍或术后第3天的浓度或作为需要放射或手术干预，导致胆道集合或胆汁性腹膜炎。这个标准的胆漏严重程度分类的使用根据其对病人的临床管理的影响。A级胆漏的原因没有改变病人的临床管理。AB级胆漏需要积极的干预治疗，但没有再次开腹手术管理的，而在C级胆漏，再次开腹手术是必需的。

结论：

我们提出了一个简单的定义和严重性分级后肝胆胰手术治疗后胆漏。本提案中的应用，将使不同的临床试验结果可进行标准化比较，可能有助于在肝胆胰手术治疗领域的形成一个客观评价的诊断和治疗方法。

Background. Despite the potentially severe impact of bile leakage on patients’ perioperative and long-term outcome, a commonly used definition of this complication after hepatobiliary and pancreatic operations has not yet been established. The aim of the present article is to propose a uniform definition and severity grading of bile leakage after hepatobiliary and pancreatic operative therapy.

Methods. An international study group of hepatobiliary and pancreatic surgeons was convened.

A consensus definition of bile leakage after hepatobiliary and pancreatic operative therapy was developed based on the postoperat ive course of bilirubin concentrations in patients’ serum and drain fluid. Results. After evaluation of the postoperative course of bilirubin levels in the drain fluid of patients who underwent hepatobiliary and pancreatic operations, bile leakage was defined as bilirubin concentration

in the drain fluid at least 3 times the serum bilirubin concentration on or after postoperative day 3 or as the need for radiologic or operative intervention resulting from biliary collections or bile peritonitis. Using this criterion severity of bile leakage was classified according to its impact on patients’ clinical management. Grade A bile leakage causes no change in patients’ clinical management. A Grade B bile leakage requires active therapeutic intervention but is manageable without relaparotomy, whereas in Grade C, bile leakage relaparotomy is required.

Conclusion. We propose a simple definition and severity grading of bile leakage after hepatobiliary and pancreatic operative therapy. The application of the present proposal will enable a standardized comparison of the results of different clinical trials and may facilitate an objective evaluation of diagnostic and therapeutic modalities in the field of hepatobiliary and pancreatic operative therapy. (Surgery 2011;149:680-8.)