World J Gastroenterol. 2012 Nov 21;18(43):6177-82. doi: 10.3748/wjg.v18.i43.6177.
Biliary ductal changes are a common radiological finding in patients with portal hypertension, however only a small percentage of patients (5%-30%) develop symptomatic bile duct obstruction. The exact pathogenesis is not clear, but an involvement of factors such as bile duct compression by venous collaterals, ischemia, and infection is accepted by most authors. Although endoscopic retrograde cholangiopancreatography was used to define and diagnose this condition, magnetic resonance cholangiopancreatography is currently the investigation of choice for diagnosing this condition. Treatment is indicated only for symptomatic cases. Portosystemic shunts are the treatment of choice for symptomatic portal biliopathy. In the majority of patients, the changes caused by biliopathy resolve after shunt surgery, however, 15%-20% patients require a subsequent bilio-enteric bypass or endoscopic management for persistent biliopathy. There is a role for endoscopic therapy in patients with bile duct stones, cholangitis or when portosystemic shunt surgery is not feasible.
胆管变化是门脉高压患者的常见影像学发现，但只有一小部分患者（5%-30%）出现症状性胆管梗阻。确切的发病机制尚不清楚，但大多数作者认为静脉侧支压迫胆管、缺血和感染等因素的参与。虽然内镜逆行胰胆管造影术用于定义和诊断这种情况，但磁共振胰胆管造影术目前是诊断这种情况的首选检查方法。仅对有症状的病例进行治疗。门体分流术是治疗症状性门脉胆病的首选方法。在大多数患者中，分流手术后胆病引起的变化会得到解决，但仍有 15%-20%的患者需要随后进行胆肠旁路或内镜治疗以解决持续性胆病。对于胆管结石、胆管炎或门体分流术不可行的患者，内镜治疗有一定作用。
