Björnsson Einar, Lindqvist-Ottosson Joachim, Asztely Mats, Olsson Rolf
Department of Internal Medicine, Section of Gastroenterology and Hepatology, Sahlgrenska University, Gothenburg, Sweden.
Am J Gastroenterol. 2004 Mar;99(3):502-8. doi: 10.1111/j.1572-0241.2004.04106.x.
Repeat endoscopic dilatations of dominant strictures (DS) have been reported to be of benefit in patients with primary sclerosing cholangitis (PSC). We aimed to determine the prevalence of DS in patients with PSC and the spontaneous course of ALP and bilirubin, up to a year from diagnosis in patients with and without DS.
Cholangiographies from 125 patients with PSC were reevaluated. DS was defined as a stenosis < or =1.5 mm in diameter of the common bile duct (CBD) and/or < or = 1.0 mm of right (RHD) or left hepatic duct (LHD).
A dominant stricture in common bile duct and/or right hepatic duct or left hepatic duct was present in 56 out of 125 (45%) patients. Mean values for alkaline phosphatase were 16 and 15.2 microkat/L and bilirubin values were 42 and 35 micromol/L before cholangiography in patients with and without DS, respectively (NS). The change in ALP and bilirubin observed from the precholangiographic value up to 2 and 12 months afterward was not significantly different in those with and without DS.
Cholestasis in patients with PSC does not seem to be related to the presence of DS. Endoscopic therapy of DS should not be routinely undertaken and randomized studies are needed to clarify its potential benefits.
据报道，对原发性硬化性胆管炎（PSC）患者进行内镜下反复扩张主要狭窄（DS）有益。我们旨在确定PSC患者中DS的患病率，以及有无DS患者自诊断起长达一年的碱性磷酸酶（ALP）和胆红素的自然病程。
对125例PSC患者的胆管造影进行重新评估。DS定义为胆总管（CBD）直径≤1.5 mm和/或右肝管（RHD）或左肝管（LHD）直径≤1.0 mm的狭窄。
125例患者中有56例（45%）存在胆总管和/或右肝管或左肝管的主要狭窄。有DS和无DS患者胆管造影前碱性磷酸酶的平均值分别为16和15.2微卡特/升，胆红素值分别为42和35微摩尔/升（无显著性差异）。有DS和无DS患者从胆管造影前值到之后2个月和12个月观察到的ALP和胆红素变化无显著差异。
PSC患者的胆汁淤积似乎与DS的存在无关。DS的内镜治疗不应常规进行，需要进行随机研究以阐明其潜在益处。
