Medical Department, Baerum Hospital, Vestre Viken Hospital Trust, Drammen, Norway.
Clin Res Hepatol Gastroenterol. 2011 Dec;35(12):786-91. doi: 10.1016/j.clinre.2011.04.007. Epub 2011 Oct 1.
Guidelines for the management of primary sclerosing cholangitis (PSC) have recently been published by both the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD). The current review focuses on the management of PSC, based on these guidelines. There is no established medical therapy for PSC. The role for UDCA in slowing the disease progression and improving survival is as yet unclear, and there are no specific recommendations for the general use of UDCA in this condition. Guidelines recommend that dominant bile duct strictures with significant cholestasis should be treated with biliary dilatation, with or without stenting. Prospective studies to define type, duration, optimal frequency and long-term effects of endoscopic therapy are needed. Liver transplantation is recommended for end stage disease and has excellent results. PSC patients with dysplasia in biliary brush cytology specimens should also be considered for transplantation. There is no evidence-based algorithm for the follow-up of PSC patients, but some regular investigations are recommended (surveillance colonoscopies in patients with IBD and ultrasound to detect gallbladder mass lesions).
原发性硬化性胆管炎（PSC）的管理指南最近由欧洲肝脏研究协会（EASL）和美国肝病研究协会（AASLD）发布。本综述基于这些指南，重点关注 PSC 的管理。目前尚无针对 PSC 的既定医学治疗方法。UDCA 减缓疾病进展和提高生存率的作用尚不清楚，因此不建议在这种情况下常规使用 UDCA。指南建议对有明显胆汁淤积的主导性胆管狭窄进行胆道扩张治疗，可联合或不联合支架置入。需要进行前瞻性研究来确定内镜治疗的类型、持续时间、最佳频率和长期效果。对于终末期疾病，推荐进行肝移植，且效果极佳。对于胆道刷检细胞学标本有异型增生的 PSC 患者，也应考虑进行移植。目前尚无针对 PSC 患者随访的循证算法，但建议进行一些常规检查（IBD 患者的结肠镜监测和超声以检测胆囊肿块病变）。
