Luigiano Carmelo, Iabichino Giuseppe, Mangiavillano Benedetto, Eusebi Leonardo H, Arena Monica, Consolo Pierluigi, Morace Carmela, Fagoonee Sharmila, Barabino Matteo, Opocher Enrico, Pellicano Rinaldo
Unit of Digestive Endoscopy, San Paolo Hospital, Milan, Italy -
Minerva Chir. 2016 Dec;71(6):398-406. Epub 2016 Sep 2.
Bile duct injuries (BDIs) are the most serious complications after hepatobiliary surgery and are associated with high morbidity and mortality. The incidence of iatrogenic injuries of bile ducts has increased after the advent of laparoscopic cholecystectomy. BDIs present with biliary leak or biliary obstruction or a combination of both. Successful treatment of these complications requires a multidisciplinary team that includes biliary endoscopists, interventional radiologists and hepatobiliary surgeons. Endoscopic treatment is the main option for biliary leak. Depending on colangiographic appearance of the biliary damage, several endoscopic techniques (naso-biliary drainage, biliary sphincterotomy, placement of prosthesis) are used, allowing to achieve the leak sealing in most cases. In complex biliary fistulas the use of covered self-expandable metal stents is another therapeutic option with high success rates. The most common endoscopic therapy for biliary strictures involves balloon dilation and placement of multiple plastic stents followed by the periodic exchange of the stents. This is usually performed every three months by placing an increasing number of stents each time, until complete resolution of the stricture. Self-expandable metal stents have a larger diameter compared to plastic stents and therefore, higher patency rate. Covered self-expandable stents are an alternative option with the advantage of providing better permeability, preventing occlusion, and reducing the number of the required procedures. The aim of this paper was to review the endoscopic management of patients with bile duct injuries after hepatobiliary surgery.
胆管损伤（BDIs）是肝胆手术后最严重的并发症，与高发病率和死亡率相关。随着腹腔镜胆囊切除术的出现，医源性胆管损伤的发生率有所增加。BDIs表现为胆漏或胆管梗阻或两者兼有。成功治疗这些并发症需要一个多学科团队，包括胆道内镜医师、介入放射科医生和肝胆外科医生。内镜治疗是胆漏的主要选择。根据胆管损伤的胆管造影表现，可采用几种内镜技术（鼻胆管引流、胆管括约肌切开术、放置假体），在大多数情况下可实现漏口封闭。在复杂胆瘘中，使用覆膜自膨式金属支架是另一种成功率较高的治疗选择。胆管狭窄最常见的内镜治疗包括球囊扩张和放置多个塑料支架，随后定期更换支架。这通常每三个月进行一次，每次放置越来越多的支架，直到狭窄完全消除。与塑料支架相比，自膨式金属支架直径更大，因此通畅率更高。覆膜自膨式支架是一种替代选择，其优点是具有更好的通透性，可防止堵塞，并减少所需的操作次数。本文的目的是综述肝胆手术后胆管损伤患者的内镜治疗。
