Ragozzino Alfonso, De Ritis Rosaria, Mosca Alessandro, Iaccarino Vittorio, Imbriaco Massimo
Department of Radiology, Cardarelli Hospital, Via Pansini 5, Via Manzoni 214/0, Naples 80123, Italy.
AJR Am J Roentgenol. 2004 Dec;183(6):1567-72. doi: 10.2214/ajr.183.6.01831567.
Our aim was to determine the diagnostic role of MR cholangiography in the evaluation of iatrogenic bile duct injuries after cholecystectomy.
Nineteen patients (14 women and five men; mean age, 47 years; age range, 24-75 years) with suspected bile duct injury as a result of laparoscopic cholecystectomy (17 patients) and open cholecystectomy (two patients) underwent MR cholangiography. MR images were evaluated for bile duct discontinuity, presence or absence of biliary dilation, stricture, excision injury, free fluid, and collections. Bile duct excision and stricture were classified according to the Bismuth classification. Final diagnosis was made on the basis of findings at surgery in 15 patients, on percutaneous transhepatic cholangiography (PTC) in one patient, and on endoscopic retrograde cholangiography (ERC) and at clinical follow-up until hospital discharge in the remaining three patients.
In 16 patients, injury of the bile duct was observed. Two patients had Bismuth type I injury; one patient, type II injury; 11 patients, type III injury; and one patient each, type IV and V injuries. Three patients showed findings suggestive of leakage from the cystic duct remnant, which were confirmed on ERC.
MR cholangiography is an accurate diagnostic technique in the identification of postoperative bile duct injuries. This technique allows exploration above and below the level of obstruction, a resource provided by neither ERC nor PTC, and allows the accurate classification of these injuries, which is essential for treatment planning.
我们的目的是确定磁共振胰胆管造影（MR cholangiography）在评估胆囊切除术后医源性胆管损伤中的诊断作用。
19例因腹腔镜胆囊切除术（17例）和开腹胆囊切除术（2例）怀疑有胆管损伤的患者（14例女性和5例男性；平均年龄47岁；年龄范围24 - 75岁）接受了磁共振胰胆管造影检查。对磁共振图像进行评估，观察胆管连续性、有无胆管扩张、狭窄、切除损伤、游离液体及积液情况。胆管切除和狭窄根据Bismuth分类法进行分类。15例患者根据手术所见做出最终诊断，1例患者根据经皮经肝胆管造影（PTC）做出诊断，其余3例患者根据内镜逆行胰胆管造影（ERC）及直至出院的临床随访结果做出诊断。
16例患者观察到胆管损伤。2例为Bismuth I型损伤；1例为II型损伤；11例为III型损伤；IV型和V型损伤各1例。3例患者表现出提示胆囊管残端渗漏的征象，经ERC证实。
磁共振胰胆管造影是识别术后胆管损伤的一种准确诊断技术。该技术能够探查梗阻平面上下的情况，这是ERC和PTC都无法提供的，并且能够对这些损伤进行准确分类，这对于治疗方案的制定至关重要。
