Weismüller T J, Lankisch T O
Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover.
Dtsch Med Wochenschr. 2011 Apr;136(14):713-6. doi: 10.1055/s-0031-1274571. Epub 2011 Mar 29.
This article focuses on the new insights and developments in biliary tract disorders. In patients with large bile duct stones, balloon dilation after the after endoscopic sphincterotomy appears to be an effective alternative to mechanical lithotripsy. A 2-month biliary stenting reduces stone size and number of stones. Early laparoscopic cholecystectomy in patients with cholezysto- and choledocholithiasis appears to be safe and might prevent biliary complications in the period following sphincterotomy. A bile sample collected during cholangiography for microbiological analysis is a simple, potentially valuable, diagnostic tool in patients with cholangitis. Each center should recognize its own patterns of infection to ensure ideal targeted therapy. In patients with primary biliary cirrhosis (PBC), development of fatigue is an independent risk factor of increased mortality. The risk of osteoporosis is increased in women with PBC and their risk of fracture increased significantly already at a T-score lower than -1.5. For PBC-patients not responding on UDCA-therapy, fenofibrate may be a new therapeutic approach. The incidence of primary sclerosing cholangitis (PSC) increases significantly in Scandinavia. In PSC patients with dominant stenosis the additional presence of inflammatory bowel disease is associated with an increased risk of cancer and a decreased survival. The risk of osteoporosis in PSC patients is significantly increased, especially in those with long-standing inflammatory bowel disease. In patients with advanced cholangiocarcinoma, bilateral stenting of the bile ducts is associated with better prognosis. The combination therapy with gemcitabine and cisplatin is an appropriate option for the treatment of patients with advanced biliary cancer.
本文重点关注胆道疾病的新见解和新进展。对于患有大胆管结石的患者，内镜括约肌切开术后进行球囊扩张似乎是机械碎石术的一种有效替代方法。为期2个月的胆道支架置入可减小结石大小并减少结石数量。对于患有胆囊和胆总管结石的患者，早期腹腔镜胆囊切除术似乎是安全的，并且可能预防括约肌切开术后一段时间内的胆道并发症。在胆管造影期间采集胆汁样本进行微生物分析，对于胆管炎患者而言是一种简单且可能有价值的诊断工具。每个中心都应了解自身的感染模式，以确保进行理想的靶向治疗。在原发性胆汁性肝硬化（PBC）患者中，疲劳的出现是死亡率增加的独立危险因素。PBC女性患骨质疏松症的风险增加，并且在T值低于-1.5时其骨折风险就已显著增加。对于对熊去氧胆酸（UDCA）治疗无反应的PBC患者，非诺贝特可能是一种新的治疗方法。原发性硬化性胆管炎（PSC）的发病率在斯堪的纳维亚半岛显著增加。在患有主导性狭窄的PSC患者中，合并存在炎症性肠病会增加患癌风险并降低生存率。PSC患者患骨质疏松症的风险显著增加，尤其是那些患有长期炎症性肠病的患者。对于晚期胆管癌患者，双侧胆管支架置入与更好的预后相关。吉西他滨和顺铂联合治疗是晚期胆管癌患者治疗的合适选择。
