Régent D, Laurent V, Meyer-Bisch L, Barbary-Lefèvre C, Corby-Ciprian S, Mathias J
Service de Radiologie Adultes, CHU du Brabois, Allée du Morvan, 54511 Vandoeuvre-Les-Nancy Cedex.
J Radiol. 2006 Apr;87(4 Pt 2):413-29. doi: 10.1016/s0221-0363(06)74024-0.
Biliary colic is the most common clinical presentation of symptomatic gallstone disease, whatever its localisation (cholelithiasis or choledocolithiasis). The pain of biliary colic is unfortunately called "colic", a word suggesting paroxystic bouts and usually described as localised in the right upper quadrant. In fact, biliary pain is most frequently epigastric in location, usually starts abruptly to generally persists without fluctuation and resolve gradually over two to four hours. Biliary lithiasis has a high prevalence in the population, especially in elderly women but only 20% of the patients are symptomatic and among them, only 10 to 20% experience severe pain. Misdiagnosis is frequent with potential disastrous implications, especially with other causes of epigastric pain (atypical myocardial ischemia, perforated ulcer, etc.). Non invasive imaging of the biliary tract is now generally easy to obtain; abdominal ultrasound for gallbladder stones and magnetic resonance cholangiography for the main bile duct and the intrahepatic bile ducts. But, for gallbladder stones, the greatest care must be taken by the radiologist to link up the symptomatology and the cholelithiasis. Precise description of the abdominal pain (nature, intensity, location, duration, irradiation...) is needed and must be searched by the radiologist to prevent misdiagnosis.
胆绞痛是有症状胆结石疾病最常见的临床表现，无论其结石位于何处（胆囊结石或胆管结石）。遗憾的是，胆绞痛的疼痛被称为“绞痛”，这个词意味着阵发性发作，通常被描述为局限于右上腹。事实上，胆绞痛的疼痛位置最常位于上腹部，通常突然发作，一般持续存在且无波动，并在两到四个小时内逐渐缓解。胆结石在人群中患病率很高，尤其是老年女性，但只有20%的患者有症状，其中只有10%至20%经历严重疼痛。误诊很常见，可能会带来灾难性后果，尤其是与其他引起上腹部疼痛的原因（非典型心肌缺血、穿孔性溃疡等）相关时。现在一般很容易获得胆道的非侵入性影像检查；腹部超声用于检查胆囊结石，磁共振胆胰管造影用于检查胆总管和肝内胆管。但是，对于胆囊结石，放射科医生必须格外小心，将症状与胆结石联系起来。需要对腹痛进行精确描述（性质、强度、位置、持续时间、放射部位等），放射科医生必须仔细询问，以防止误诊。
