Válek Vlastimil, Kala Zdenek, Kysela Petr
Department of Radiology, University Hopistal Brno, Jihlavská 20, 63900 Brno, Czech Republic.
Eur J Radiol. 2005 Mar;53(3):433-40. doi: 10.1016/j.ejrad.2004.12.014.
Recently, with improvements in surgical techniques there has been a substantial reduction in the incidence of biliary complications of hepatobiliary surgery. Nevertheless, bile duct injuries and other post-cholecystectomy complications are a serious problem and a major cause of morbidity and mortality. Early complications may include bile duct injury caused by mistakenly placed clips, erroneous cutting of bile ducts based on misinterpretation of biliary anatomy, periductal bile leakage that causes edema, fibrosis and secondary stricturing, and ischemia due to injury to the right hepatic artery. Bile duct strictures are the most common of the late complications and can develop a few months or many years after surgery. Early detection and accurate diagnosis have a fundamental importance for the successful treatment of these complications. Therefore, early and meaningful application of the imaging methods immediately after detection of the first symptoms is essential. Peroperative ultrasound and direct iodine contrast application into the biliary tree (operative cholangiography) are highly important for immediate visualization of the complications during surgery. Ultrasound can be used to aid in identification of ductal structures and the cholangiogram should be obtained to document the anatomy. Plain abdominal film could be made in the patients in poor clinical conditions after biliary surgery. Oral cholecystography has largely been replaced by ultrasonography (US) for evaluation of cholelithiasis and complications like post-cholecystectomy fluid collections. The same methodology replaced the conventional intravenous cholangiography. Nowadays computed tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP), magnetic resonance cholangiography (MRCP) and ultrasound (US) have essential roles as primary imaging modalities after biliary tree and gallbladder surgery in the evaluation of associated complications and residual biliary stones. We review the role of the imaging in complications after biliary tree and gallbladder surgery.
近年来，随着外科技术的进步，肝胆外科手术中胆系并发症的发生率已大幅降低。然而，胆管损伤及其他胆囊切除术后并发症仍是一个严重问题，是发病和死亡的主要原因。早期并发症可能包括因夹子放置错误导致的胆管损伤、基于胆管解剖结构误判而错误切断胆管、导致水肿、纤维化及继发性狭窄的胆管周围胆汁渗漏，以及右肝动脉损伤引起的缺血。胆管狭窄是最常见的晚期并发症，可在术后数月或数年出现。早期发现和准确诊断对于成功治疗这些并发症至关重要。因此，在首次出现症状后立即早期且有意义地应用成像方法至关重要。术中超声及直接向胆管树内注入碘造影剂（术中胆管造影）对于术中即时观察并发症非常重要。超声可用于辅助识别胆管结构，应进行胆管造影以记录解剖结构。对于胆道手术后临床状况较差的患者，可拍摄腹部平片。口服胆囊造影在很大程度上已被超声（US）所取代，用于评估胆石症及胆囊切除术后积液等并发症。同样的方法取代了传统的静脉胆管造影。如今，计算机断层扫描（CT）、内镜逆行胰胆管造影（ERCP）、磁共振胆胰管造影（MRCP）和超声（US）在胆管树和胆囊手术后评估相关并发症及残余胆管结石方面作为主要成像方式发挥着重要作用。我们综述了成像在胆管树和胆囊手术后并发症中的作用。
