2016胆石症课件.ppt

预防胆管结石复发 UDCA在胆石症中的应用进展 浙江大学医学院附属第二医院 陆新良 西方国家：10%~15%，中国：0.9%~10% 美国2000年60亿美元，中国：？ 欧美胆固醇结石75%，中国：52%~79% Despite the frequency of the condition, many patients with gallstones remain undiagnosed, although symptoms and/or complications occur in approximately a third of patients. 易感因素 4F现象：Fat、Female、Fertilize、Forty In China, the prevalence of cholesterol gallstones seems to increase with the Westernization of the traditional Chinese diet.High efficiency of intestinal cholesterol absorption and high dietary cholesterol seem to be key and independent risk factors for the formation of cholesterol gallstones. Cholesterol gallstones are associated with well-known risk factors, such as obesity,type 2 diabetes, dyslipidemia, and hyperinsulinemia, which are often components of the metabolic syndrome epidemic, which has a prevalence greater than 35% in the adult population and which continues to increase in Westernized countries The complex pathogenesis of cholesterol gallstones depends on the concurrent existence of hepatic hypersecretion of cholesterol into bile, leading to bile supersaturation with cholesterol, accelerated nucleation/crystallization of cholesterol in gallbladder bile, impaired gallbladder motility leading to gallbladder stasis, and increased cholesterol availability from the small intestine 胆固醇结石形成机制 Anatomical abnormalities causing bile stasis might be major risk factors. Parasitic infection is also associated with primary duct stones as well as intrahepatic bile duct stones, particularly in Asia 胆管结石形成机制 Stone core formation is initiated by bacterial infection and subsequent bilirubin deconjugation Bile composition may eventually change to precipitate cholesterol Similarly, such precipitates and/or microcalculi can act as nuclei to induce bacterial colonization, which may in due course enhance precipitation of calcium bilirubinate or modify original cores. 胆管结石形成机制 a single gene defect causes bile duct and gallbladder stones in a defined subgroup – y