Clinical value of methylene blue test in the prevention of the bile leakage after excision of internal capsule combined with external capsular subtotal resection of hepatic cystic echinococcosis / 中华消化外科杂志

ABSTRACT

Objective To investigate the clinical value of methylene blue test detecting intraoperative surgical wounds in prevention of the bile leakage after excision of internal capsule combined with external capsular subtotal resection of hepatic cystic echinococcosis.Methods The retrospective cohort study was conducted.The clinical data of 128 patients who underwent excision of internal capsule combined with external capsular subtotal resection of hepatic cystic echinococcosis in the Xilin Gol League Hospital of Inner Mongolia Autonomous Region between December 2008 and June 2016 were collected.Sixty-eight patients in the later stage (between May 2011 and June 2016) whose surgical wounds were detected using methylene blue test for preventing postoperative bile leakage were allocated into the study group,and 68 in the early stage (between December 2008 and April 2011)whose surgical wounds were not detected using methylene blue test were allocated into the control group.After cholecystectomy,catheters of patients in the study group were inserted into common bile duct for blocking the distal common bile duct via stump of cystic duct,and mehylene blue dilutions were injected into common bile duct via catheters,observing and judging whether or not there were blue dyes of residual cavity and bile leakage.Patients in the control group used dry gauze to wipe residual external capsular wall,and judging whether or not there was bile leakage.Observation indicators(1) surgical and postoperative recovery situations;(2) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative patients'survival and recurrence of hepatic cystic echinococcosis up to June 2017.Measurement data with normal distribution were represented as-x±s.The comparisons between groups were evaluated with the t test,and the count data were analyzed using the chi-square test.Results (1) Surgical and postoperative recovery situationsall patients between groups underwent successful surgery,without perioperative death.Dominant and recessive bile leakages were detected in 30,34 patients in the study group and 15,10 patients in the control group,respectively.Operation time,volume of intraoperative blood loss,time of postoperative gastrointestinal function recovery,time of postoperative drainage-tube removal,cases with postoperative bile leakage and duration of postoperative hospital stay were respectively (191±37)minutes,(156±20) mL,(2.8±1.5) days,(6.4±2.5) days,8,(10.3±2.5)days in the study group and (137±22) minutes,(115±11)mL,(2.2±1.2)days,(9.5±3.9)days,22,(13.5±3.8)days in the control group,with statistically significant differences between groups (t =9.944,14.540,2.477,-5.415,x2 =11.015,t =-5.689,P＜0.05).Number of patients with postoperative incision liquefaction and infection,residual cavity abscess and jaundice were respectively 5,2,0,0 in the study group and 6,3,1,1 in the control group,with no statistically significant difference between groups (x2 =0.284,0.360,1.142,1.142,P＞0.05).Patients with postoperative bile leakage received sufficient drainage,patients with postoperative incision liquefaction and infection received drainage and changing dressing,patients with residual cavity abscess received tube placement by reoperation and sufficient drainage and patients with jaundice received liver-and cholagogic-protective treatments.All the patients with complications were improved.(2) Follow-up120 of 128 patients were followed up for 6-36 months,including 66 in the study gorup and 54 in the control group,with a median time of 24 months.During the follow-up,all patients were survived;3 patients had recurrence of hepatic cystic echinococcosis,including 2 undergoing reoperation and 1 undergoing albendazole treatment.Conclusion Methylene blue test detecting intraoperative surgical wounds has better clinical value in prevention of the bile leakage after excision of internal capsule combined with external capsular subtotal resection of hepatic cystic echinococcosis.