Costamagna Guido, Iacopini Federico, Familiari Pietro
Unidad de Endoscopia Digestiva, Departamento de Cirugía, Università Cattolica "A. Gemelli", Rome, Italy.
Rev Gastroenterol Mex. 2005 Jul;70 Suppl 1:83-94.
Endoscopic retrograde cholangiopancreatography (ERCP) plays a first role both in the diagnosis and treatment of postoperative biliary leaks as well as of benign strictures. The goal of the endoscopic treatment of biliary leaks is the elimination of the transpapillary pressure gradient, but the choice of the best approach remains to be established. ES should be sufficient to treat the leaks without an associated lesion of the extrahepatic bile ducts. In these cases, placement of a NBD for two to three days has the advantage to allow checking the healing. Placement of a plastic stent is indicated for leaks of the main ducts to remodel the healing process and try to prevent the development of strictures. An endoscopic attempt should be also considered in severely injured bile ducts especially in those cases unfit for surgery. Benign biliary strictures have been traditionally treated by surgical repair but today endoscopy represents the preferred treatment since the stricture can be completely and permanently dilated in a big proportion of patients. The use of rendezvous procedures by combining ERCP and PTC may increase the number of potential candidates for non-operative treatment. The advantages of endoscopy are its simplicity, repeatability and minimal invasiveness; furthermore, surgery after endotherapy is always possible.
内镜逆行胰胆管造影术（ERCP）在术后胆漏及良性狭窄的诊断和治疗中均发挥着首要作用。胆漏内镜治疗的目标是消除经乳头压力梯度，但最佳治疗方法的选择仍有待确定。内镜下括约肌切开术应足以治疗胆漏且不伴有肝外胆管损伤。在这些情况下，放置鼻胆管引流两到三天有助于检查愈合情况。对于主胆管漏，放置塑料支架可重塑愈合过程并试图预防狭窄形成。对于严重损伤的胆管，尤其是那些不适合手术的病例，也应考虑进行内镜治疗尝试。传统上，良性胆管狭窄通过手术修复治疗，但如今内镜检查已成为首选治疗方法，因为在很大一部分患者中狭窄能够被完全且永久性地扩张。联合ERCP和经皮肝穿刺胆管造影术（PTC）使用会师操作可能会增加非手术治疗的潜在候选人数。内镜检查的优点在于其操作简单、可重复性强且创伤极小；此外，内镜治疗后总是可以进行手术。
