Bajaj Jasmohan S, Dua Kulwinder S
Division of Gastroenterology and Hepatology, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226, USA.
Curr Gastroenterol Rep. 2007 Apr;9(2):147-50. doi: 10.1007/s11894-007-0009-0.
Traumatic noniatrogenic biliary injuries, unlike iatrogenic injuries, are usually complex in nature and are frequently associated with other multiorgan trauma and infection. Bile leaks following these injuries are an important source of short- and long-term morbidity. Repeat surgery for primary repair of complex bile leaks is difficult and can be complicated by anastomotic leakage and biliary stricture formation. Endoscopic retrograde cholangiopancreatography (ERCP) was initially used only as a diagnostic technique to guide surgical repair in this setting. However, with the high success rates observed in treatment of iatrogenic bile leaks, ERCP has emerged as a nonoperative treatment option for noniatrogenic biliary leaks as well. Recent data show that ERCP is effective in managing bile leaks after blunt and sharp liver injuries, using transpapillary stenting, endoscopic sphincterotomy, or both, with greater than 80% healing rates. The evidence is not clear regarding which ERCP maneuver - endoscopic sphincterotomy, transpapillary stenting, or both - should be used.
与医源性损伤不同，创伤性非医源性胆管损伤通常性质复杂，常伴有其他多器官创伤和感染。这些损伤后的胆漏是短期和长期发病的重要来源。对复杂胆漏进行初次修复的再次手术困难，且可能因吻合口漏和胆管狭窄形成而复杂化。内镜逆行胰胆管造影术（ERCP）最初仅用作诊断技术，在此情况下指导手术修复。然而，鉴于在医源性胆漏治疗中观察到的高成功率，ERCP也已成为非医源性胆漏的一种非手术治疗选择。最近的数据表明，使用经乳头支架置入术、内镜括约肌切开术或两者结合，ERCP在处理钝性和锐性肝损伤后的胆漏方面有效，愈合率超过80%。关于应使用哪种ERCP操作——内镜括约肌切开术、经乳头支架置入术或两者结合——证据并不明确。
