Abstract:

Objective To explore an effective surgical intervention strategy for hepatic echinococcosis complicated with intracystic bile leakage. Methods The clinical data of patients of hepatic echinococcosis complicated with intracystic bile leakage were collected from January 2015 to February 2021 in the Third People Hospital of Xinjiang and analyzed retrospectively. The patients were divided into 3 groups according to different surgical procedures. The cases that had experienced residual cavity drainage after inner cyst excised were categorized into the control group. The cases that had received additional T-tube drainage via common bile duct during operation were categorized into the drainage group. The cases that had received endoscopic retrograde biliary drainage were categorized into the endoscopic retrograde biliary drainage (ERBD) group. Of all three groups of patients, visible bile leaks in the residual cavity were routinely sutured. Operation time, amount of blood loss during operation, indwelling time of residual drainage tube, indwelling time of T-tube/inner stent, time length of hospital stay, the total number of hospital re-entry, post-surgery short-term complication rate and the occurrence rate of returning to hospital due to complication were compared, using SPSS 22.0 statistical software. Results A total of 70 patients hepatic echinococcosis complicated with intracystic bile leakage were enrolled, including 44 males and 26 females, 26 in the control group, 24 in the drainage group, and 20 in the ERBD group. The differences in patient characteristics between the three groups were not statistically significant (χ²_Gender = 0.24, F_Age = 1.12, χ²_{No. lesion} = 1.56, χ²_{Max diameter of lesion} = 0.36, χ²_{Primary location of lesion} = 0.45, χ²_{Type of lesion} = 2.61; P > 0.05). The operative time for the control group, the drainage group and the ERBD group were (154.42 ± 27.14), (188.13 ± 17.62), and (205.00 ± 22.48) min, respectively, with statistically significant difference between the goups (F = 29.62, P < 0.05). The volume of blood loss during operation for the control group, the drainage group and the ERBD group were (203.85 ± 43.37), (218.33 ± 43.61) and (210.00 ± 38.53) ml, showing no significant difference between the groups(F = 0.74, P > 0.05). The indwelling time of residual drainage tube for the control group, the drainage group and the ERBD group were (9.15 ± 9.95), (2.38 ± 0.49) and (2.80 ± 0.83) weeks respectively, presenting no significant difference between the drainage group and the ERBD group (t = 2.60, P > 0.05). However, the indwelling time in the drainage group and ERBD group was significantly shorter than that in the control group (F = 9.55, P < 0.05). The indwelling time of T-tube or stent in the drainage group and the ERBD group were (4.96 ± 0.69) and (7.15 ± 2.32) weeks respectively, of which the difference was statistically significant (t = 186.48, P < 0.05). The length of hospital stay (first + last) of the control group, the drainage group and the ERBD group were (4.04 ± 1.51), (2.17 ± 0.38) and (3.65 ± 0.67) weeks respectively, there was no significant difference between the drainage group and the ERBD group (t = 8.28, P > 0.05). However, the time length of hospital stay of drainage group and the ERBD group were both significantly shorter than that of the control group (F = 23.08, P < 0.05). The total number of hospital re-entry for the control group, the drainage group and the ERBD group were (0.58 ± 0.90), (0.08 ± 0.28) and (1.10 ± 0.31), among which the re-entry time of the drainage group was fewer than the control group, while the ERBD group showed more times (F = 29.62, P < 0.05). Eighteen patients had postsurgery short-term complications in the control group, 8 cases in the drainage group and 10 cases in the ERBD group, between them no significant difference was found (χ² = 3.35, P > 0.05). Fifteen patients were readmitted to hospitals due to related complications in the control group, 1 patient in the drainage group and 2 patients in the ERBD group. Readmission in the drainage group and the ERBD group were both significantly fewer than that in the control group (χ ² = 12.51, 7.94, P < 0.05), and there was no significant difference between the drainage group and the ERBD group (χ ² = 0.58, P > 0.05). Conclusion The technique of residual cavity drainage for inner cyst excision in combination with T-tube drainage via common bile duct or ERBD could significantly improve the clinical treatment efficacy and shorten the treatment cycle for those hepatic echinococcosis patients complicated with intracystic bile leakage with common bile duct larger than 6 mm in diameter.

Key words: Cystic hepatic echinococcosis, Biliary leakage, T-tube drainage, Biliary stent insertion