Risk factors for bile leakage after hepatectomy without biliary reconstruction: A Meta - analysis / 临床肝胆病杂志

ABSTRACT

Objective To investigate the risk factors for bile leakage after hepatectomy without biliary reconstruction. Methods CNKI, Wanfang Data, VIP, PubMed, Embase, Web of Science, and The Cochrane Library were searched for English and Chinese study reports on the risk factors for bile leakage after hepatectomy without biliary reconstruction published up to April 2021. The method of Cochrane systematic review was used for literature screening and data extraction, and Newcastle-Ottawa Scale was used for quality assessment. RevMan 5.4 software was used to perform a meta-analysis of the extracted data. Results A total of 16 articles (13 in English and 3 in Chinese) were included in this study, with a total of 16036 cases. The meta-analysis showed that sex (odds ratio [ OR ]=1.27, 95% CI : 1.09-1.48, P =0.003), diabetes ( OR =1.23, 95% CI : 1.07-1.41, P =0.003), past history of liver surgery ( OR =2.50, 95% CI : 1.74-3.59, P < 0.001), anatomic hepatectomy ( OR =1.58, 95% CI : 1.09-2.30, P =0.02), segment I hepatectomy ( OR =2.56, 95% CI : 1.50-4.40, P < 0.001), central hepatectomy (S4, S5, S8) ( OR =3.51, 95% CI : 2.80-4.40, P < 0.001), left third hepatectomy ( OR =3.53, 95% CI : 2.32-5.36, P < 0.001), and intraoperative blood transfusion ( OR =2.64, 95% CI : 1.93-3.60, P < 0.001) were the risk factors for bile leakage after hepatectomy. Liver cirrhosis, preoperative liver function grade, preoperative chemotherapy, and left/right hemihepatectomy were not the risk factors for bile leakage. Conclusion There are complex influencing factors for bile leakage after hepatectomy, and in addition to the patient's own factors such as sex, diabetes, and past history of liver surgery, intraoperative factors, such as surgical procedures, extent of hepatectomy, and intraoperative blood transfusion, are also risk factors for bile leakage after hepatectomy. The surgeon should conduct adequate preoperative assessment and perform careful operation during surgery to reduce the incidence rate of postoperative bile leakage.