Abstract：
Bile leaks arise from various causes such as trauma, complications after hepatobiliary surgery, and intrahepatic malignancies or their associated liver-directed treatments. Bile leaks can result in significant morbidity and mortality. Delayed diagnosis is not uncommon due to nonspecific manifestations; therefore, a high clinical suspicion is needed. A multidisciplinary approach for treatment of biliary leaks with prompt referral to tertiary care centers with experienced hepatobiliary surgeons, advanced endoscopists, and interventional radiologists is needed to address these challenging complications. Management of biliary leaks can range from conservative management to open surgical repair. Minimally invasive procedures play a crucial role in biliary leak treatment, and the interventional radiologist can help guide appropriate management on the basis of a clear understanding of the pathophysiology of biliary leaks and a current knowledge of the armamentarium of treatment options. In most cases, a simple diversion of bile to decompress the biliary system may prove effective. However, persistent and high-output biliary leaks require delineation of the source with tailored treatment options to control the leak. This may be done by additional diversions, occluding the source, reestablishing connections, or using a combination of therapies to bridge to more definitive surgical interventions. The authors describe the different treatment options and emphasize the role of interventional radiology. ©RSNA, 2024.
摘要：
胆汁渗漏是由各种原因引起的，如外伤，肝胆手术后的并发症，和肝内恶性肿瘤或其相关的肝定向治疗。胆汁渗漏可导致显著的发病率和死亡率。由于非特异性表现，延迟诊断并不少见；因此，需要高度的临床怀疑。采用多学科方法治疗胆漏，并迅速转诊至经验丰富的肝胆外科医生的三级护理中心，高级内窥镜医师,需要介入放射科医师来解决这些具有挑战性的并发症。胆漏的管理范围可以从保守管理到开放手术修复。微创手术在胆漏治疗中起着至关重要的作用，介入放射科医生可以在清楚了解胆漏的病理生理学和对治疗方案的最新知识的基础上，帮助指导适当的治疗。在大多数情况下,一个简单的转移胆汁减压胆道系统可能被证明是有效的。然而,持续和高输出的胆漏需要通过量身定制的治疗方案来划分来源以控制泄漏。这可以通过额外的改道来实现，遮挡源，重新建立连接,或使用组合疗法来桥接更明确的手术干预。作者描述了不同的治疗方案，并强调了介入放射学的作用。©RSNA,2024.
