Abstract: Risk factors of Grade B/C bile leakage after hepatobiliary resection for perihilar cholangiocarcinoma based on ISGLS definition        CHEN Xiao-yuan*，MAO Liang，SUN Shi-quan，et al. *Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University，Nanjing 21008，China
Corresponding author：QIU Yu-dong，E-mail：yudongqiu510@163.com
Abstract  Objective  To investigate the risk factors for Grade B/C bile leakage (clinical-related bile leakage) after hepatobiliary resection due to perihilar cholangiocarcinoma based on ISGLS definition. Methods  A total of 73 consecutive patients with perihilar cholangiocarcinoma who underwent hepatobiliary resection at Department of Hepatobiliary and Pancreatic Surgery of Nanjing Drum Tower Hospital between September 2010 and July 2019 were enrolled. Clinical records were reviewed for multivariate analysis to find independent risk factors for postoperative Grade B/C bile leakage. In the cohort，14 patients（19.2%） with clinical-related bile leakage were set as the bile leakage group，and the remaining 59 patients (80.8%) were set as the non-bile leakage group. Results  The bile leakage group had higher incidence of postoperative infections (85.7% vs. 55.9%)，serve complications (64.3% vs. 28.8%) and prolonged hospital-stay (more than 30 d) (64.3% vs. 30.5%) than non-bile leakage group（P<0.05）. Our study investigated 4 independent risk factors. Gamma-glutamyl transpeptidase (GGT) on postoperative day (POD) 1 （OR=1.005，95%CI 1.001-1.010，P=0.015，Optimal cut-off value=209.4 U/L），number of bile duct anastomosis (OR=3.101，95%CI 1.161-8.288，P=0.024)，Klebsiella pneumoniae isolated from pre-/intraoperative bile cultures (OR=6.791，95%CI 1.254-36.783，P=0.026) and preoperative cholangitis (OR=4.662，95%CI 1.045-20.804，P=0.044). The area under the receiver operating characteristic (ROC) curve was 0.882 (P=0.000，95%CI 0.678-0.967). Conclusion  GGT on POD 1，number of bile duct anastomosis，Klebsiella pneumoniae isolated from per-/intraoperative bile cultures and preoperative cholangitis are independent risk factors for Grade B/C bile leakage，which can provide a reference for the perioperative management of patients with PHCC.

Key words: perihilar cholangiocarcinoma；postoperative complications；bile leakage, risk factors

摘要： 目的    探讨肝门部胆管癌（PHCC）病人行根治性切除术后发生临床相关胆瘘的危险因素。方法    回顾性分析2010年9月至2019年7月南京大学医学院附属鼓楼医院肝胆胰外科收治的连续73例行根治性手术的PHCC病人的临床病理资料。根据国际肝脏外科研究组（ISGLS）术后胆瘘分级，将B、C级胆瘘定义为临床相关胆瘘。将发生临床相关胆瘘的14例病人作为胆瘘组，未发生胆瘘和发生A级胆瘘的59例病人为无胆瘘组。通过多因素分析确定术后临床相关胆瘘的独立危险因素。结果    胆瘘组感染性并发症（85.7% vs. 55.9%）、严重并发症（64.3% vs. 28.8%）及术后住院时间>30 d发生率（64.3% vs. 30.5%）均高于无胆瘘组（P<0.05）。术后第1天γ谷酰转肽酶（GGT）（OR=1.005，95%CI 1.001~1.010，P=0.015，最佳截断值209.4 U/L）、胆肠吻合口数量（OR=3.101，95%CI 1.161~8.288，P=0.024）、术前或术中胆汁培养肺炎克雷伯菌阳性（OR=6.791，95%CI 1.254~36.783，P=0.026）和术前胆管炎（OR=4.662，95%CI 1.045~20.804，P=0.044）是术后发生临床相关胆瘘的独立危险因素。预测模型ROC曲线下面积（AUC）=0.822（P=0.000，95%CI 0.678~0.967）。结论    PHCC病人行根治性切除术后第1天GGT、胆肠吻合口数量、术前或术中胆汁培养肺炎克雷伯菌阳性和术前胆管炎是术后发生临床相关胆瘘的独立危险因素，对符合指征的病人应积极行胆道引流并定期监测围手术期胆汁病原学。

关键词: 肝门部胆管癌, 术后并发症, 胆瘘, 危险因素