Messing B, Bories C, Kunstlinger F, Bernier J J
Gastroenterology. 1983 May;84(5 Pt 1):1012-9.
To assess the prevalence of sludge formation and lithiasis during total parenteral nutrition, serial biliary ultrasonographic studies were performed during and after i.v. nutrition periods in 23 selected adult gastroenterological patients. All patients were free of hepatobiliary disease before i.v. nutrition. Initial sonograms of 19 patients taken at the 12th day +/- 2 days (mean +/- SEM) of i.v. nutrition were normal. Initial studies for the 4 remaining patients, which were performed on the 39th day +/- 10 days of i.v. therapy (p less than 0.001), showed gallbladder sludge but did not demonstrate lithiasis. Serial ultrasonographic studies indicated that the percentage of sludge-positive patients during parenteral nutrition increased from 6% during the first 3 wk to 50% between the fourth and the sixth weeks and reached 100% in patients receiving i.v. nutritional therapy for greater than 6 wk. Gallstone formation was demonstrated in 6 of 14 sludge-forming patients but was not observed in patients who were sludge-negative. Three of the 6 stone-forming patients underwent cholecystectomy because of complications secondary to cholelithiasis after a mean 43-day course of parenteral nutrition. Analysis of bile from these patients revealed thick bile-containing cholesterol crystals and small stones of mixed bilirubin-cholesterol type. Ultrasonographic studies were obtained for sludge-positive patients after the parenteral nutrition period. Sludge positivity decreased from 88% during the first 3 wk of oral refeeding to 0% by the end of the fourth week. This study, therefore, strongly suggests that bowel rest and bile stasis during parenteral nutrition lead to production of sludge, which can result in eventual gallstone formation. Consequently, during parenteral nutrition exceeding 1 mo, gallbladder stasis should be palliated to prevent cholelithiasis formation.
为评估全胃肠外营养期间胆泥形成和结石症的发生率，对23例选定的成年胃肠病患者在静脉营养期间及之后进行了系列胆道超声检查。所有患者在静脉营养前均无肝胆疾病。19例患者在静脉营养第12天±2天（均值±标准误）的初始超声检查结果正常。其余4例患者在静脉治疗第39天±10天（P<0.001）进行的初始检查显示有胆囊胆泥，但未发现结石。系列超声检查表明，胃肠外营养期间胆泥阳性患者的比例从最初3周的6%增加到第4至6周的50%，在接受静脉营养治疗超过6周的患者中达到100%。14例形成胆泥的患者中有6例出现胆结石形成，而胆泥阴性患者未观察到胆结石形成。6例形成结石的患者中有3例在平均43天的胃肠外营养疗程后因胆石症继发并发症而接受了胆囊切除术。对这些患者胆汁的分析显示胆汁浓稠，含有胆固醇结晶和胆红素 - 胆固醇混合型小结石。在胃肠外营养期后对胆泥阳性患者进行了超声检查。胆泥阳性率从口服再喂养最初3周的88%降至第4周结束时的0%。因此，本研究强烈提示，胃肠外营养期间肠道休息和胆汁淤积会导致胆泥产生，进而可能导致最终胆结石形成。因此，在胃肠外营养超过1个月时，应缓解胆囊淤积以预防胆石症形成。
