Ellrichmann Mark, Bösenkötter Jannes, Schoch Stephan, Conrad Claudio Cim
Interdisciplinary Endoscopy, Medical Department 1, University Hospital Schleswig-Holstein, Kiel, Germany.
Visc Med. 2025 Apr 21:1-8. doi: 10.1159/000545742.
Biliary leakages are notable complications that can occur following hepatobiliary surgery, traumatic injury, or iatrogenic causes related to medical interventions. The management of biliary leaks is critical as untreated leaks can result in severe complications such as biliary peritonitis, abscess formation, and sepsis.
Treatment approaches for biliary leaks are highly variable and depend on the severity and anatomical location of the leak. Options range from conservative management and endoscopic interventions to surgical repair in more severe cases. A clear understanding of the classification of biliary leaks - whether anatomical, etiological, or severity-based - is essential to guide appropriate treatment strategies and improve clinical outcomes. Notably, several endoscopic techniques are now available and have significantly enhanced patient outcomes, even in complex surgical anatomies.
The management of biliary duct leaks requires a comprehensive approach that includes endoscopic, percutaneous, and surgical interventions. The choice of treatment is determined by the severity of the leak, the patient's overall condition, and the specific context of the injury. Endoscopic retrograde cholangiopancreatography in combination with sphincterotomy and stent placement is widely regarded as the first-line treatment when the papilla is conventionally accessible.
胆漏是肝胆手术、外伤或与医疗干预相关的医源性原因后可能发生的显著并发症。胆漏的处理至关重要，因为未经治疗的胆漏可导致严重并发症，如胆汁性腹膜炎、脓肿形成和脓毒症。
胆漏的治疗方法差异很大，取决于漏口的严重程度和解剖位置。治疗选择范围从保守治疗、内镜干预到更严重病例的手术修复。清楚了解胆漏的分类——无论是解剖学、病因学还是基于严重程度的分类——对于指导适当的治疗策略和改善临床结果至关重要。值得注意的是，现在有几种内镜技术可供使用，即使在复杂的手术解剖结构中，也显著改善了患者的治疗效果。
胆管漏的处理需要综合方法，包括内镜、经皮和手术干预。治疗方法的选择取决于漏口的严重程度、患者的整体状况以及损伤的具体情况。当乳头常规可及 时，内镜逆行胰胆管造影术联合括约肌切开术和支架置入术被广泛视为一线治疗方法。
