Yeh T S, Jan Y Y, Tseng J H, Hwang T L, Jeng L B, Chen M F
Department of Surgery, Chang-Gung Memorial Hospital, Chang-Gung University, Taipei, Taiwan.
Br J Surg. 1999 Feb;86(2):181-4. doi: 10.1046/j.1365-2168.1999.01029.x.
Conventionally, recognition of bile duct injuries after laparoscopic cholecystectomy largely relies on endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC). However, these invasive procedures are not without risk. Preliminary experience with use of magnetic resonance cholangiopancreatography (MRCP) to identify these injuries is reported.
The medical records of five patients who had undergone laparoscopic cholecystectomy and had suspected major bile duct injuries were reviewed. All five patients underwent MRCP, followed by conventional cholangiography: either ERCP or PTC, or both. The findings of MRCP and conventional cholangiography were compared.
Four patients had proven bile duct injuries. The remaining patient had gallstones dislodged into the common bile duct (CBD) during laparoscopic cholecystectomy, which presented as transient jaundice mimicking a bile duct injury. The MRCP images were of higher diagnostic value than conventional cholangiographic images in four patients with frank bile duct injury. For these patients, ERCP showed only the cut-off sign of the CBD, and PTC was needed to visualize the upper biliary system. MRCP, however, demonstrated the entire biliary system proximal and distal to the amputated or stenotic sites simultaneously. In the remaining patient with dislodged gallstones, the two techniques yielded similar diagnostic information.
This preliminary study suggests that MRCP is an ideal diagnostic test whenever bile duct injury following laparoscopic cholecystectomy is suspected.
传统上，腹腔镜胆囊切除术后胆管损伤的识别很大程度上依赖于内镜逆行胰胆管造影（ERCP）和经皮经肝胆管造影（PTC）。然而，这些侵入性操作并非没有风险。本文报道了使用磁共振胰胆管造影（MRCP）识别这些损伤的初步经验。
回顾了5例接受腹腔镜胆囊切除术且怀疑有主要胆管损伤患者的病历。所有5例患者均接受了MRCP检查，随后进行了传统胆管造影：ERCP或PTC，或两者都做。比较了MRCP和传统胆管造影的结果。
4例患者证实有胆管损伤。其余1例患者在腹腔镜胆囊切除术中胆结石掉入胆总管（CBD），表现为类似胆管损伤的短暂黄疸。在4例明确胆管损伤的患者中，MRCP图像的诊断价值高于传统胆管造影图像。对于这些患者，ERCP仅显示CBD的截断征，需要PTC来观察上胆道系统。然而，MRCP可同时显示截断或狭窄部位近端和远端的整个胆道系统。在其余胆结石掉入的患者中，这两种技术提供了相似的诊断信息。
这项初步研究表明，每当怀疑腹腔镜胆囊切除术后胆管损伤时，MRCP是一种理想的诊断检查方法。
