Shaffer E A
Faculty of Medicine, Department of Medicine, Foothills Hospital, Room C210, 1403 29th Street NW, Calgary, AB T2N 2T9, Canada.
Curr Gastroenterol Rep. 2001 Apr;3(2):166-73. doi: 10.1007/s11894-001-0015-6.
Biliary sludge is a mixture of particulate solids that have precipitated from bile. Such sediment consists of cholesterol crystals, calcium bilirubinate pigment, and other calcium salts. Sludge is usually detected on transabdominal ultrasonography. Microscopy of aspirated bile and endoscopic ultrasonography are far more sensitive. Biliary sludge is associated with pregnancy; with rapid weight loss, particularly in the obese; with critical illness involving low or absent oral intake and the use of total parenteral nutrition (TPN); and following gastric surgery. It is also associated with biliary stones with common bile duct obstruction; with certain drugs, such as ceftriaxone and octreotide; and with bone marrow or solid organ transplantation. The clinical course of biliary sludge varies. It often vanishes, particularly if the causative event disappears; other cases wax and wane, and some go on to gallstones. Complications caused by biliary sludge include biliary colic, acute cholangitis, and acute pancreatitis. Asymptomatic patients with sludge or microlithiasis require no therapy. When patients are symptomatic or if complications arise, cholecystectomy is indicated. For the elderly or those at risk from the surgery, endoscopic sphincterotomy can prevent recurrent episodes of pancreatitis. Medical therapy is limited, although some approaches may show promise in the future.
胆泥是从胆汁中沉淀出来的颗粒状固体混合物。这种沉淀物由胆固醇结晶、胆红素钙色素和其他钙盐组成。胆泥通常通过腹部超声检查发现。抽吸胆汁的显微镜检查和内镜超声检查更为敏感。胆泥与妊娠有关；与体重快速下降有关，尤其是肥胖者；与涉及口服摄入少或无口服摄入以及使用全胃肠外营养（TPN）的危重病有关；以及与胃手术后有关。它还与伴有胆总管梗阻的胆结石有关；与某些药物有关，如头孢曲松和奥曲肽；以及与骨髓或实体器官移植有关。胆泥的临床病程各不相同。它常常会消失，尤其是如果致病因素消失的话；其他情况则有反复，还有一些会发展为胆结石。胆泥引起的并发症包括胆绞痛、急性胆管炎和急性胰腺炎。无症状的胆泥或微结石患者无需治疗。当患者出现症状或发生并发症时，应行胆囊切除术。对于老年人或手术风险高的患者，内镜括约肌切开术可预防胰腺炎的复发。药物治疗有限，尽管一些方法未来可能会有前景。
