Similarities and differences between biliary sludge and microlithiasis: Their clinical and pathophysiological significances.
Similarities and differences between biliary sludge and microlithiasis: Their clinical and pathophysiological significances.
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DOI：
10.1016/j.livres.2018.10.001
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发表时间：
2018-12-01
期刊：
影响因子：
--
通讯作者：
Wang, David Q-H
中科院分区：
文献类型：
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作者：
Wang, Helen H;Portincasa, Piero;Wang, David Q-H
胆汁淤泥和胆固醇微结石(以下简称微结石)这两个术语来源于不同的诊断技术，可能代表胆固醇结石疾病的不同阶段。虽然胆泥和微结石的发病机制可能相似，但微结石可能先于胆泥，然后是固体胆固醇晶体的持续沉淀和聚集，最终形成胆结石。许多临床情况明显与胆泥和微结石的形成有关，包括完全肠外营养、快速减肥、怀孕、器官移植、某些药物的使用以及各种急慢性疾病。大量研究表明，大约40%的患者胆汁淤泥完全消退，约40%的患者出现周期性的消失和复发，近20%的患者进展为胆结石。虽然只有一小部分超声检查显示有胆泥的患者会发展为胆结石，但微石症是否最终会演变为胆固醇结石仍是一个有争议的问题。胆泥和微结石在绝大多数患者中是无症状的，但它们可导致胆绞痛、急性胆囊炎和急性胰腺炎。超声检查最常诊断胆泥和微石症，胆汁镜检被认为是诊断的金标准。防止胆汁淤泥发展的具体措施在普通人群中是不实际的，也不符合成本效益。腹腔镜胆囊切除术为胆汁淤积提供了最可靠的治疗方法。内窥镜下乳头括约肌切开术或外科手术是治疗微石性胰腺炎的有效方法。熊去氧胆酸可有效预防固体胆固醇结晶复发，显著降低胰腺炎复发风险。
The terms biliary sludge and cholesterol microlithiasis (hereafter referred to as microlithiasis) were originated from different diagnostic techniques and may represent different stages of cholesterol gallstone disease. Although the pathogenesis of biliary sludge and microlithiasis may be similar, microlithiasis could be preceded by biliary sludge, followed by persistent precipitation and aggregation of solid cholesterol crystals, and eventually, gallstone formation. Many clinical conditions are clearly associated with the formation of biliary sludge and microlithiasis, including total parenteral nutrition, rapid weight loss, pregnancy, organ transplantation, administration of certain medications, and a variety of acute and chronic illnesses. Numerous studies have demonstrated complete resolution of biliary sludge in approximately 40% of patients, a cyclic pattern of disappearing and reappearing in about 40%, and progression to gallstones in nearly 20%. Although only a minority of patients with ultrasonographic demonstration of biliary sludge develop gallstones, it is still a matter of controversy whether microlithiasis could eventually evolve to cholesterol gallstones. Biliary sludge and microlithiasis are asymptomatic in the vast majority of patients; however, they can cause biliary colic, acute cholecystitis, and acute pancreatitis. Biliary sludge and microlithiasis are most often diagnosed ultrasonographically and bile microscopy is considered the gold standard for their diagnosis. Specific measures to prevent the development of biliary sludge are not practical or cost-effective in the general population. Laparoscopic cholecystectomy offers the most definitive therapy on biliary sludge. Endoscopic sphincterotomy or surgical intervention is effective for microlithiasis-induced pancreatitis. Ursodeoxycholic acid can effectively prevent the recurrence of solid cholesterol crystals and significantly reduce the risk of recurrent pancreatitis.