Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110, USA.
Radiographics. 2013 Jan-Feb;33(1):117-34. doi: 10.1148/rg.331125044.
Bile duct injuries are infrequent but potentially devastating complications of biliary tract surgery and have become more common since the introduction of laparoscopic cholecystectomy. The successful management of these injuries depends on the injury type, the timing of its recognition, the presence of complicating factors, the condition of the patient, and the availability of an experienced hepatobiliary surgeon. Bile duct injuries may lead to bile leakage, intraabdominal abscesses, cholangitis, and secondary biliary cirrhosis due to chronic strictures. Imaging is vital for the initial diagnosis of bile duct injury, assessment of its extent, and guidance of its treatment. Imaging options include cholescintigraphy, ultrasonography, computed tomography, magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, and fluoroscopy with a contrast medium injected via a surgically or percutaneously placed biliary drainage catheter. Depending on the type of injury, management may include endoscopic, percutaneous, and open surgical interventions. Percutaneous intervention is performed for biloma and abscess drainage, transhepatic biliary drainage, U-tube placement, dilation of bile duct strictures and stent placement to maintain ductal patency, and management of complications from previous percutaneous interventions. Endoscopic and percutaneous interventional procedures may be performed for definitive treatment or as adjuncts to definitive surgical repair. In patients who are eligible for surgery, surgical biliary tract reconstruction is the best treatment option for most major bile duct injuries. When reconstruction is performed by an experienced hepatobiliary surgeon, an excellent long-term outcome can be achieved, particularly if percutaneous interventions are performed as needed preoperatively to optimize the patient's condition and postoperatively to manage complications.
胆管损伤是胆道手术罕见但潜在的严重并发症，自腹腔镜胆囊切除术问世以来，其发生率有所增加。这些损伤的成功处理取决于损伤类型、识别时间、是否存在合并症、患者状况和经验丰富的肝胆外科医生的可用性。胆管损伤可导致胆汁漏、腹腔脓肿、胆管炎和继发性胆汁性肝硬化，原因是慢性狭窄。影像学检查对于胆管损伤的初步诊断、损伤程度的评估和治疗的指导至关重要。影像学检查的选择包括核素胆系扫描、超声检查、计算机断层扫描、磁共振胰胆管造影、内镜逆行胰胆管造影、经皮经肝胆管造影术和荧光透视检查，通过手术或经皮放置的胆道引流导管注入造影剂。根据损伤类型，治疗可能包括内镜、经皮和开放手术干预。经皮介入用于胆汁瘤和脓肿引流、经肝胆汁引流、U 型管放置、胆管狭窄扩张和支架放置以保持胆管通畅，以及处理先前经皮介入的并发症。内镜和经皮介入程序可用于确定性治疗或作为确定性手术修复的辅助手段。对于适合手术的患者，手术胆道重建是大多数主要胆管损伤的最佳治疗选择。如果由经验丰富的肝胆外科医生进行重建，则可以获得良好的长期结果，特别是如果在术前需要时进行经皮介入以优化患者状况，以及在术后进行介入以处理并发症。
