Background In liver resection, bile leakage remains the most common cause of operative morbidity. In order to predict the risk of this complication on the basis of various factors, we developed a clinical score system to predict the potential risk of bile leakage after liver resection. Methods We analyzed the postoperative course in 518 patients who underwent liver resection for malignancy to identify independent predictors of bile leakage, which was defined as “a drain fluid bilirubin concentration at least three times the serum bilirubin concentration on or after postoperative day 3,” as proposed by the International Study Group of Liver Surgery. To confirm the robustness of the risk score system for bile leakage, we analyzed the independent series of 289 patients undergoing liver resection for malignancy. Results Among 81 (15.6?%) patients with bile leakage, 76 had grade A bile leakage, and five had grade C leakage and underwent reoperation. The median postoperative hospital stay was significantly longer in patients with bile leakage (median, 14?days; range, 8 to 34) than in those without bile leakage (11?days; 5 to 62; P =?0.001). There was no hepatic insufficiency or in-hospital death. The risk score model was based on the four independent predictors of postoperative bile leakage: non-anatomical resection (odds ratio, 3.16; 95?% confidence interval [CI], 1.72 to 6.07; P Conclusions Our risk score model can be used to predict the risk of bile leakage after liver resection.
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机译：背景技术在肝脏切除术中，胆汁渗漏仍然是手术发病率的最常见原因。为了在各种因素的基础上预测这种并发症的风险，我们开发了一种临床评分系统来预测肝脏切除术后胆漏的潜在风险。方法我们分析了518例行肝脏切除术的恶性肿瘤患者的术后病程，以确定胆汁渗漏的独立预测因子，其定义为“术后3天或之后的排出液胆红素浓度至少为血清胆红素浓度的三倍”，由国际肝脏外科研究小组提出。为了确认胆汁渗漏风险评分系统的稳健性，我们分析了289例行肝切除术的恶性肿瘤患者的独立系列。结果在81例（15.6％）胆汁渗漏患者中，有76例为A级胆汁渗漏，其中5例为C级渗漏并接受了再次手术。胆汁渗漏患者的中位术后住院时间（中位数为14天;范围为8到34天）比无胆汁渗漏患者的中位住院时间明显更长（11天; 5到62天; P = 0.001）。没有肝功能不全或住院死亡。风险评分模型基于术后胆汁渗漏的四个独立预测因子：非解剖切除（比值比为3.16; 95％置信区间[CI]为1.72至6.07; P结论）我们的风险评分模型可用于预测肝切除后胆汁泄漏的风险。
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