Pazzi P, Gamberini S, Buldrini P, Gullini S
Department of Gastroenterology and Digestive Endoscopy, S. Anna Hospital, Ferrara, Italy.
Dig Liver Dis. 2003 Jul;35 Suppl 3:S39-45. doi: 10.1016/s1590-8658(03)00093-8.
Biliary sludge is a mixture of particulate matter which has precipitated from bile. It generally consists of cholesterol monohydrate crystals, calcium bilirubinate or other calcium salts. In a clinical setting, biliary sludge is almost always an ultrasonographic diagnosis. Although it is less clinically applicable, direct microscopic examination of gallbladder bile is far more sensitive than ultrasonography into sludge detection, and has to be regarded as the diagnostic gold standard. The overall prevalence of sludge in the general population is relatively low. However, several clinical conditions are associated with a particularly high prevalence of biliary sludge, including pregnancy, rapid weight loss, total parenteral nutrition, octreotide therapy, bone marrow or solid organ transplantation. The clinical course of biliary sludge varies, and complete resolution, a waxing and waning course, and progression to gallstones are all possible outcomes. It may cause complications usually associated with gallstones, such as biliary colic, acute cholecystitis, and acute pancreatitis. The main pathogenic mechanism involved in sludge formation is probably gallbladder dismotility, and in selected patients measures aimed to maintain adequate gallbladder contractions has been shown to effectively prevent sludge development.
胆泥是从胆汁中沉淀出来的颗粒物混合物。它通常由一水合胆固醇晶体、胆红素钙或其他钙盐组成。在临床环境中，胆泥几乎总是通过超声诊断。虽然在临床应用中较少，但对胆囊胆汁进行直接显微镜检查在检测胆泥方面比超声检查敏感得多，必须被视为诊断金标准。一般人群中胆泥的总体患病率相对较低。然而，几种临床情况与胆泥的特别高患病率相关，包括怀孕、快速减重、全胃肠外营养、奥曲肽治疗、骨髓或实体器官移植。胆泥的临床过程各不相同，完全消退、病情起伏以及发展为胆结石都是可能的结果。它可能引发通常与胆结石相关的并发症，如胆绞痛、急性胆囊炎和急性胰腺炎。胆泥形成所涉及的主要致病机制可能是胆囊运动障碍，并且在部分患者中，旨在维持足够胆囊收缩的措施已被证明能有效预防胆泥形成。
