Fujii T, Maguchi H, Obara T, Tanno S, Itoh A, Shudo R, Takahashi K, Saito H, Ura H, Kohgo Y
Third Department of Internal Medicine, Asahikawa Medical College, Hokkaido, Japan.
Hepatogastroenterology. 1998 May-Jun;45(21):656-61.
BACKGROUND/AIMS: The purpose of this study was to evaluate the efficacy of endoscopic approaches for the diagnosis and treatment of postoperative biliary leak.
Endoscopic retrograde cholangiopancreatography (ERCP) was performed in eight patients with postoperative biliary leak. Of 8 cases, 6 had biliary leak alone (4 cases with a cystic duct leak and 2 cases with a bile duct leak) and 2 cases with a bile duct leak were associated with a bile duct stricture. Endoscopic sphincterotomy (ES) and endoscopic biliary stenting (EBS) were employed in 5 patients and nasobiliary tube drainage (NBD) without ES was performed in 3 patients.
In all the patients, ERCP was successfully performed and could demonstrate exact nature and site of postoperative bile duct injuries. In 2 patients with a concomitant bile duct stricture, repetitive endoprosthesis placements were required. The remaining six patients with biliary leak alone were successfully treated by temporary stenting, i.e., ES and EBS (n = 3), and NBD (n = 3).
The patients with postoperative biliary leaks can be successfully diagnosed by ERCP and treated by temporary endoscopic methods. Among various endoscopic treatments, NBD alone appears to be preferable in treating patients with small bile leaks. However, cases with a concomitant bile duct stricture were intractable and required longer period of stenting.
背景/目的：本研究旨在评估内镜方法对术后胆漏的诊断及治疗效果。
对8例术后胆漏患者行内镜逆行胰胆管造影（ERCP）。8例中，6例为单纯胆漏（4例胆囊管漏，2例胆管漏），2例胆管漏合并胆管狭窄。5例患者采用内镜括约肌切开术（ES）及内镜胆管支架置入术（EBS），3例患者未行ES仅行鼻胆管引流（NBD）。
所有患者均成功完成ERCP，且能明确术后胆管损伤的具体性质及部位。2例合并胆管狭窄的患者需反复置入内支架。其余6例单纯胆漏患者通过临时支架置入成功治愈，即ES及EBS（3例）和NBD（3例）。
术后胆漏患者可通过ERCP成功诊断，并采用临时内镜方法治疗。在各种内镜治疗中，单纯NBD似乎更适合治疗小胆漏患者。然而，合并胆管狭窄的病例治疗棘手，需要更长时间的支架置入。
