Oral dissolution treatment of gallstones with bile acids.
Oral dissolution treatment of gallstones with bile acids.
复制标题
用胆汁酸口服溶解胆结石治疗。
DOI：
10.1055/s-2008-1040472
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发表时间：
1990
影响因子：
4.2
通讯作者：
Shefer,S
中科院分区：
文献类型：
--
作者：
Salen,G;Tint,GS;Shefer,S
据估计，有2500万美国人患有胆结石，约占美国总人口的10%。虽然每年新诊断的病例有100万例，但这个问题的严重性实际上可能被低估了，因为大多数胆结石患者仍然没有症状，因此经常被发现。~胆结石最典型的症状是疼痛(胆绞痛)，这是由小结石或砾石通过胆管引起的。一般来说，疼痛位于右上腹，随着结石从胆囊管通过胆囊管到达胆总管并出口到十二指肠，疼痛向中线和背部辐射。胆结石患者的其他常见症状包括腹胀、打嗝、胀气、恶心和呕吐。这些症状通常集中在一起，称为胆汁性消化不良。胆汁性消化不良的病因尚未确定，可能与结石的运动没有直接关系，而是与胆囊肌和胆管的功能障碍有关。显然，胆结石的存在可能会对协调的肌肉收缩产生不利影响，并可能导致胆囊和胆管运动障碍。这种异常的运动功能也可能导致胆汁回流到胃中的增加，导致所谓的胆汁反流性胃炎。尽管病因尚不明确，但这些症状一旦出现，往往会反复出现，经常伴随进食，产生不适，并预示着更严重的并发症的发展，如胆囊炎、梗阻性黄疸、上行性胆管炎和胰腺炎。后一种并发症发生在结石移动并阻塞胆囊管、胆总管或胰管时。根据目前的治疗建议，胆结石的这些并发症的发展通常需要立即手术治疗：1987年进行的50万例胆囊切除术中，约有三分之一(15万例)是紧急手术。另外三分之二(35万例)是在患者病情不严重的时候作为择期手术进行的。
It is estimated that 25 million Americans, or about 10% of the US population, have gallstones." Although 1 million new cases are diagnosed annually, the magnitude of this problem may actually be underestimated, because most patients with gallstones remain asymptomatic and therefore often go~ ndetected.'.~ The most typical symptom of gallstones is pain (biliary colic), which is caused by the passage of small stones or gravel through the bile ducts. Generally, the pain is located in the right upper quadrant and radiates to the midline and back as the stones pass from the gallbladder through the cystic duct to reach the common bile duct and exit into the duodenum. Other common symptoms found in subjects who have gallstones include abdominal distension, belching, flatulence, nausea, and vomiting. These symptoms are often grouped together and called biliary dyspepsia. The etiology of biliary dyspepsia has not been defined and may not be related directly to the movement of the stones, but rather to muscular dysfunction of the gallbladder and bile ducts. Apparently, the presence of gallstones may adversely affect coordinated muscular contractions and may lead to dyskinesia of the gallbladder and bile ducts. This abnormal motor function may also allow for increased bile reflux into the stomach, resulting in so-called bile-reflux gastritis. Despite the imprecise knowledge of the cause, these symptoms, when present, tend to be recurrent, often follow eating, produce discomfort, and presage the development of more serious complications such as cholecystitis, obstructive jaundice, ascending cholangitis, and pancreatitis. The latter complications occur when stones move and obstruct the cystic, common bile, or pancreatic ducts. According to present therapeutic recommendations, the development of these complications of gallstones often requires immediate surgical intervention: about one-third (150,000) of the 500,000 cholecystectomies performed in 1987 were emergency operations.'The other two-thirds (350,000) of the cholecystectomies were performed as elective operations at a time when the patients were not acutely ill.