University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA.
J Am Coll Radiol. 2013 Aug;10(8):567-74. doi: 10.1016/j.jacr.2013.03.017. Epub 2013 Jun 12.
The optimal treatment for patients with biliary obstruction varies depending on the underlying cause of the obstruction, the clinical condition of the patient, and anticipated long-term effects of the procedure performed. Endoscopic and image-guided procedures are usually the initial procedures performed for biliary obstructions. Various options are available for both the radiologist and endoscopist, and each should be considered for any individual patient with biliary obstruction. This article provides an overview of the current status of radiologic procedures performed in the setting of biliary obstruction and describes multiple clinical scenarios that may be treated by radiologic or other methods. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
对于胆道梗阻患者，最佳的治疗方法取决于梗阻的根本原因、患者的临床状况以及手术预期的长期效果。内镜和影像引导下的操作通常是胆道梗阻初始的治疗方法。对于放射科医生和内镜医生来说，有多种选择，并且对于任何胆道梗阻的个体患者都应考虑这些选择。本文概述了当前在胆道梗阻情况下进行的放射学操作的现状，并描述了多种可能通过放射学或其他方法治疗的临床情况。ACR 适宜性标准是针对具体临床情况的循证指南，由多学科专家小组每两年审查一次。指南的制定和审查包括对同行评议期刊中当前医学文献的广泛分析，并应用成熟的共识方法（改良 Delphi 法）由专家组对影像学和治疗程序的适宜性进行评分。在证据不足或不明确的情况下，可以使用专家意见来推荐影像学或治疗。
