Mallick Bipadabhanjan, Anand Anil C
Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar, India.
J Clin Exp Hepatol. 2022 Mar-Apr;12(2):551-559. doi: 10.1016/j.jceh.2021.09.011. Epub 2021 Sep 16.
Gallstones are more common in patients with cirrhosis of the liver, and the incidence increases with severity of liver disease. Pigment stones are the most frequent type of gallstones (GSs) in cirrhotics, and majority remain asymptomatic. Hepatitis C virus infection and nonalcoholic fatty liver disease are the underlying etiologies of liver diseases that most often associated with GSs. Multiple altered mechanisms in cirrhosis such as chronic hemolysis due to hypersplenism, reduced bile acid synthesis and transport, decreased cholesterol secretion, decreased apolipoprotein A-I and A-II secretion, gallbladder hypo-motility, autonomic dysfunction, and portal hypertension collectively lead to increased risk of lithogenesis. Asymptomatic GSs should be followed up closely and offered laparoscopic cholecystectomy once symptomatic in Child-Pugh class A and B patients. The model for the end-stage liver disease score is the best predictor of the outcome after cholecystectomy. In patients of Child-Pugh class C, conservative or minimally invasive approaches should be used to treat complications of GSs.
胆结石在肝硬化患者中更为常见，且发病率随肝病严重程度的增加而上升。色素结石是肝硬化患者中最常见的胆结石类型，大多数患者无症状。丙型肝炎病毒感染和非酒精性脂肪性肝病是最常与胆结石相关的肝病潜在病因。肝硬化中的多种机制改变，如脾功能亢进导致的慢性溶血、胆汁酸合成和转运减少、胆固醇分泌减少、载脂蛋白A-I和A-II分泌减少、胆囊运动功能减退、自主神经功能障碍以及门静脉高压，共同导致结石形成风险增加。对于无症状的胆结石，应密切随访，一旦Child-Pugh A级和B级患者出现症状，应进行腹腔镜胆囊切除术。终末期肝病模型评分是胆囊切除术后预后的最佳预测指标。对于Child-Pugh C级患者，应采用保守或微创方法治疗胆结石并发症。
