Lanzini A, Lanzarotto F, Baisini O, Amato M, Benini F
Internal Medicine 1, Spedali Civili and University of Brescia, 25100 Brescia, Italy.
Dig Liver Dis. 2003 Jul;35 Suppl 3:S46-50. doi: 10.1016/s1590-8658(03)00094-x.
Measurement of gallbladder motility is a powerful research tool, but its value in clinical practice is uncertain. Three main conditions have been investigated for potential clinical application of this measurement. The first potential application is for identification of patients at risk of recurrence following gallstone dissolution with medical therapy. Results in this clinical setting are disappointing due to the low positive predictive value for gallstone recurrence in sluggish gallbladder emptying. The second potential application is for identification of obese patients at risk of gallstone formation during rapid weight loss. In this condition, a high negative predictive value has been reported for a normal gallbladder emptying pattern. The third potential application is for patients with recurrent biliary colic and acalcolous gallbladder disease. The diagnostic value of a provocative test involving intravenous cholecystokinin injection as a method of identifying patients likely to benefit from cholecystectomy is uncertain, partly as a consequence of non-standardized methodology. The balance of evidence reported in this review suggests a low inherent value of measurement of gallbladder motility in clinical practice. Acalcolous gallbladder disease is the clinical setting deserving further investigation on the value of the cholecystokinin provocative test, but this test needs to be standardized.
胆囊运动功能的测量是一种强大的研究工具，但其在临床实践中的价值尚不确定。针对该测量方法的潜在临床应用，主要研究了三种主要情况。第一个潜在应用是用于识别经药物治疗溶解胆结石后有复发风险的患者。由于胆囊排空迟缓时胆结石复发的阳性预测值较低，在这种临床情况下的结果令人失望。第二个潜在应用是用于识别在快速减肥期间有胆结石形成风险的肥胖患者。在这种情况下，据报道胆囊排空模式正常具有较高的阴性预测值。第三个潜在应用是针对复发性胆绞痛和无结石性胆囊疾病的患者。通过静脉注射胆囊收缩素进行激发试验作为一种识别可能从胆囊切除术中获益的患者的方法，其诊断价值尚不确定，部分原因是方法未标准化。本综述中报道的证据平衡表明，胆囊运动功能测量在临床实践中的内在价值较低。无结石性胆囊疾病是值得进一步研究胆囊收缩素激发试验价值的临床情况，但该试验需要标准化。
