Gallstones 胆结石
 Gallstones form when liquid stored in the gallbladder hardens into pieces of stone-like material.胆结石时，液态的形式储存在胆囊变硬成块石头一样的材料。 The liquid, called bile, is used to help the body digest fats.液体，称为胆汁，是用来帮助身体消化脂肪。 Bile is made in the liver, then stored in the gallbladder until the body needs to digest fat.胆汁是在肝脏中，然后储存在胆囊，直到身体需要消化脂肪。 At that time, the gallbladder contracts and pushes the bile into a tube--called the common bile duct--that carries it to the small intestine, where it helps with digestion.当时，合同和胆囊胆汁推到管-所谓胆总管-携带到小肠，在那里与它有助于消化。
Bile contains water, cholesterol, fats, bile salts, proteins, and bilirubin.胆汁含有水，胆固醇，脂肪，胆汁盐，蛋白质，和胆红素。 Bile salts break up fat, and bilirubin gives bile and stool a yellowish color.胆盐打破脂肪，和胆红素使胆汁和粪便黄颜色。 If the liquid bile contains too much cholesterol, bile salts, or bilirubin, under certain conditions it can harden into stones.如果胆汁的液体含有太多胆固醇，胆盐，或胆红素，在一定条件下可以硬化成石头。
 The two types of gallstones are cholesterol stones and pigment stones.这两个类型的胆结石是胆固醇结石和色素结石。 Cholesterol stones are usually yellow-green and are made primarily of hardened cholesterol.胆固醇结石通常是黄绿色，并主要硬化胆固醇。 They account for about 80 percent of gallstones.他们占了大约百分之八十的胆结石。 Pigment stones are small, dark stones made of bilirubin.色素结石小，皮肤黝黑石头制成的胆红素。 Gallstones can be as small as a grain of sand or as large as a golf ball.胆结石可小一粒沙子或大高尔夫球。 The gallbladder can develop just one large stone, hundreds of tiny stones, or almost any combination.胆囊可以发展只是一个大石头，数以百计的小石块，或几乎任何组合。
The gallbladder and the ducts that carry bile and other digestive enzymes from the liver, gallbladder, and pancreas to the small intestine are called the biliary system .胆囊及胆管胆汁携带和其他消化酶的肝脏，胆囊和胰腺的小肠被称为胆道系统 。
Gallstones can block the normal flow of bile if they lodge in any of the ducts that carry bile from the liver to the small intestine.胆结石可以阻止的正常流通胆汁如果他们提出的任何导管携带胆汁从肝脏小肠。 That includes the hepatic ducts, which carry bile out of the liver; the cystic duct, which takes bile to and from the gallbladder; and the common bile duct, which takes bile from the cystic and hepatic ducts to the small intestine.这包括肝管，胆管而进行了肝脏的胆囊管，其中考虑到胆汁和胆囊和胆总管，其中考虑胆汁从胆囊和肝管的小肠。 Bile trapped in these ducts can cause inflammation in the gallbladder, the ducts, or, rarely, the liver.胆汁被困在这些导管可导致炎症的胆囊，导管，或者很少，肝脏。 Other ducts open into the common bile duct, including the pancreatic duct, which carries digestive enzymes out of the pancreas.其他导管开放进入胆总管，包括胰管，这种消化酶的胰腺。 If a gallstone blocks the opening to that duct, digestive enzymes can become trapped in the pancreas and cause an extremely painful inflammation called gallstone pancreatitis.如果一个块结石开放该管，消化酶可以成为被困在胰腺，导致一个极其痛苦的炎症称为胆石性胰腺炎。
If any of these ducts remain blocked for a significant period of time, severe--possibly fatal--damage or infections can occur, affecting the gallbladder, liver, or pancreas.如果这些管道继续冻结相当长的时间，严重的-可能致命-损害或感染，就可能发生，影响了胆囊，肝，或胰腺。 Warning signs of a serious problem are fever, jaundice, and persistent pain.警告标志，一个严重的问题是发热，黄疸，和持续的疼痛。
What causes gallstones? 胆结石是什么原因？
Cholesterol Stones 胆固醇结石
Scientists believe cholesterol stones form when bile contains too much cholesterol, too much bilirubin, or not enough bile salts, or when the gallbladder does not empty as it should for some other reason.科学家认为，胆固醇结石时，胆汁的形式含有太多胆固醇，胆红素过多，或没有足够的胆盐时，或在没有胆囊癌空，因为它应该还有其他原因。
Pigment Stones 色素结石
The cause of pigment stones is uncertain.原因色素结石是不确定的。 They tend to develop in people who have cirrhosis, biliary tract infections, and hereditary blood disorders such as sickle cell anemia in which too much bilirubin is formed.他们往往在人们制定了谁肝硬化，胆道感染，以及遗传性血液病，如镰状细胞性贫血，其中太多胆红素形成。
Other Factors 其他因素
It is believed that the mere presence of gallstones may cause more gallstones to develop.据认为，仅仅是存在的胆结石可能会导致更多的胆结石发展。 However, other factors that contribute to gallstones have been identified, especially for cholesterol stones.然而，其他因素的影响，有助于胆结石已经确定，特别是胆固醇结石。
• Obesity. •肥胖。 Obesity is a major risk factor for gallstones, especially in women.肥胖是一个重要的危险因素胆结石，尤其是妇女。 A large clinical study showed that being even moderately overweight increases one's risk for developing gallstones.大量临床研究表明，即使是适度增加一个超重的风险对发展中国家胆结石。 The most likely reason is that obesity tends to reduce the amount of bile salts in bile, resulting in more cholesterol.最可能的原因是，肥胖往往减少胆盐胆汁，从而导致更多的胆固醇。 Obesity also decreases gallbladder emptying.肥胖还减少胆囊排空。
• Estrogen. •雌激素。 Excess estrogen from pregnancy, hormone replacement therapy, or birth control pills appears to increase cholesterol levels in bile and decrease gallbladder movement, both of which can lead to gallstones.过量雌激素从怀孕，激素替代疗法，或避孕药似乎胆固醇水平增加胆汁和胆囊运动减少，这可能会导致胆结石。
• Ethnicity. •族群。 Native Americans have a genetic predisposition to secrete high levels of cholesterol in bile.土著美国人有遗传倾向分泌高胆固醇的胆汁。 In fact, they have the highest rate of gallstones in the United States.事实上，他们有率最高的结石在美国。 A majority of Native American men have gallstones by age 60.大多数美国土著男性胆结石的60岁。 Among the Pima Indians of Arizona, 70 percent of women have gallstones by age 30.在皮马印第安人的亚利桑那州，百分之七十的妇女胆结石的30岁。 Mexican American men and women of all ages also have high rates of gallstones.墨西哥美洲男子和所有年龄的妇女也有较高的胆结石。
• Gender. •性别。 Women between 20 and 60 years of age are twice as likely to develop gallstones as men.女子20至60岁的人的两倍，可能发展胆结石男人。
• Age. •时代。 People over age 60 are more likely to develop gallstones than younger people.人60岁以上更有可能发展胆结石比年轻的人。
• Cholesterol-lowering drugs. •降胆固醇药物。 Drugs that lower cholesterol levels in blood actually increase the amount of cholesterol secreted in bile.药物降低胆固醇水平的血液实际增加的数额中胆固醇分泌胆汁。 This in turn can increase the risk of gallstones.这反过来可能增加患胆结石。
• Diabetes. •糖尿病。 People with diabetes generally have high levels of fatty acids called triglycerides.糖尿病人通常有高水平的脂肪酸，称为甘油三酸酯。 These fatty acids increase the risk of gallstones.这些不饱和脂肪酸增加患胆结石。
• Rapid weight loss. •快速减肥。 As the body metabolizes fat during rapid weight loss, it causes the liver to secrete extra cholesterol into bile, which can cause gallstones.随着人体代谢过程中脂肪迅速减重，它会导致肝脏分泌额外的胆固醇进入胆汁，这可能导致胆结石。
• Fasting. •禁食。 Fasting decreases gallbladder movement, causing the bile to become overconcentrated with cholesterol, which can lead to gallstones.空腹胆囊运动减少，造成胆汁成为overconcentrated胆固醇，从而导致胆结石。
Who is at risk for gallstones? 谁是胆结石的危险？
• women •妇女
• people over age 60 •人超过60岁
• Native Americans •土著美国人
• Mexican Americans •墨西哥裔美国人
• overweight men and women •超重的男性和女性
• people who fast or lose a lot of weight quickly •人谁快，或者失去了很多体重迅速
• pregnant women, women on hormone therapy, and women who use birth control pills •怀孕妇女，妇女激素治疗，而妇女谁使用避孕药
What are the symptoms? 有哪些症状？
Symptoms of gallstones are often called a gallstone "attack" because they occur suddenly.胆结石的症状往往是一个胆石“攻击” ，因为他们突然出现。 A typical attack can cause一个典型的攻击可以导致
• steady pain in the upper abdomen that increases rapidly and lasts from 30 minutes to several hours •稳定的疼痛上腹部的迅速增加和持续从30分钟到几个小时
• pain in the back between the shoulder blades •疼痛的背部之间的肩胛骨
• pain under the right shoulder •疼痛的右肩膀
• nausea or vomiting •恶心或呕吐
Gallstone attacks often follow fatty meals, and they may occur during the night.胆结石的攻击往往后续脂肪饮食，他们可能会发生在夜间。 Other gallstone symptoms include其他症状包括胆囊结石
• abdominal bloating •腹部肿胀
• recurring intolerance of fatty foods •经常容忍脂肪的食物
• colic •绞痛
• belching •打嗝
• gas •天然气
• indigestion •消化不良
People who also have the above and any of following symptoms should see a doctor right away:人们谁也有上述的任何下列症状应该去看医生马上：
• sweating •出汗
• chills •冷
• low-grade fever •低烧
• yellowish color of the skin or whites of the eyes •黄颜色的皮肤或白人的眼睛
• clay-colored stools •陶土色大便
Many people with gallstones have no symptoms.许多人与胆结石没有症状。 These patients are said to be asymptomatic, and these stones are called "silent stones."这些患者被认为无症状，这些石头被称为“沉默的石头。 ” They do not interfere in gallbladder, liver, or pancreas function and do not need treatment.他们不干预胆囊癌，肝癌，或胰腺功能，不需要治疗。
How are gallstones diagnosed? 胆结石是如何诊断？
Many gallstones, especially silent stones, are discovered by accident during tests for other problems.许多胆结石，尤其是沉默的石头，是偶然发现的测试过程中的其他问题。 But when gallstones are suspected to be the cause of symptoms, the doctor is likely to do an ultrasound exam.但是，当胆结石怀疑是事业的症状，医生可能会做超声波检查。 Ultrasound uses sound waves to create images of organs.利用超声音波创造的机关形象。 Sound waves are sent toward the gallbladder through a handheld device that a technician glides over the abdomen.声波传送对胆囊通过一个手持设备，一个技术员滑轨的腹部。 The sound waves bounce off the gallbladder, liver, and other organs such as a pregnant uterus, and their echoes make electrical impulses that create a picture of the organ on a video monitor.声波反弹胆囊，肝脏，和其他器官，如孕妇子宫，他们的回音使电脉冲，创造的图片机关的视频监控。 If stones are present, the sound waves will bounce off them, too, showing their location.如果石头都在场，这个声波将他们反弹，也显示其位置。 Ultrasound is the most sensitive and specific test for gallstones.超声是最敏感和最具体的考验胆结石。
Other tests used in diagnosis include:其他试验中使用的诊断包括：
• Computed tomography (CT) scan may show the gallstones or complications. •计算机断层扫描（ CT ）扫描可能会显示的胆结石或并发症。
• MR cholangiogram may diagnose blocked bile ducts. •议员cholangiogram可诊断胆管阻塞。
• Cholescintigraphy (HIDA scan) is used to diagnose abnormal contraction of the gallbladder or obstruction. • Cholescintigraphy （肥田扫描）是用于诊断异常收缩，胆囊或阻挠。 The patient is injected with a radioactive material that is taken up in the gallbladder, which is then stimulated to contract.病人注射放射性物质是采取了胆囊，然后刺激的合同。
• Endoscopic retrograde cholangiopancreatography (ERCP). •内镜逆行胰胆管造影（逆行胰胆管造影） 。 The patient swallows an endoscope--a long, flexible, lighted tube connected to a computer and TV monitor.病人燕子内窥镜-一个长期的，灵活的，灯火通明管连接到电脑和电视监控。 The doctor guides the endoscope through the stomach and into the small intestine.医生指导内窥镜通过胃进入小肠。 The doctor then injects a special dye that temporarily stains the ducts in the biliary system.医生然后注入特殊的染料染色暂时的导管中的胆道系统。 ERCP is used to locate and remove stones in the ducts.逆行胰胆管造影是用来寻找并移除结石导管。
• Blood tests. •抽血化验。 Blood tests may be used to look for signs of infection, obstruction, pancreatitis, or jaundice.血液检查可以用来寻找迹象感染，肠梗阻，胰腺炎，或黄疸。
Gallstone symptoms are similar to those of heart attack, appendicitis, ulcers, irritable bowel syndrome, hiatal hernia, pancreatitis, and hepatitis.胆结石的症状相似，心脏病，阑尾炎，溃疡，肠易激综合症，裂孔疝，胰腺炎，肝炎。 So accurate diagnosis is important.所以准确的诊断是非常重要的。
What is the treatment? 是什么待遇？
Surgery 手术
Surgery to remove the gallbladder is the most common way to treat symptomatic gallstones.手术切除胆囊是最常见的治疗方法症状的胆结石。 (Asymptomatic gallstones usually do not need treatment.) Each year more than 500,000 Americans have gallbladder surgery. （无症状胆结石通常不需要治疗。 ）每年都有超过500000美国人有胆囊手术。 The surgery is called cholecystectomy.该手术是所谓的胆囊切除术。
The most common operation is called laparoscopic cholecystectomy.最常见的手术是所谓的腹腔镜胆囊切除术。 For this operation, the surgeon makes several tiny incisions in the abdomen and inserts surgical instruments and a miniature video camera into the abdomen.对于这次行动中，医生提出了若干小切口在腹部插入手术器械和微型摄像机到腹部。 The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a closeup view of the organs and tissues.该相机发出了一个放大图像从身体内部的视频监控，从而使外科医生特写鉴于器官和组织。 While watching the monitor, the surgeon uses the instruments to carefully separate the gallbladder from the liver, ducts, and other structures.在观看监视器，外科医生使用的仪器仔细分离胆囊从肝脏，胆管，以及其他结构。 Then the cystic duct is cut and the gallbladder removed through one of the small incisions.然后，胆囊管是削减和取消胆囊通过一个小切口。
 Because the abdominal muscles are not cut during laparoscopic surgery, patients have less pain and fewer complications than they would have had after surgery using a large incision across the abdomen.由于腹部肌肉不会削减在腹腔镜手术，患者痛苦少，并发症少，并比他们将不得不手术后使用大切口在腹部。 Recovery usually involves only one night in the hospital, followed by several days of restricted activity at home.恢复通常只涉及一个晚上在医院，其次是数天的活动限制在家里。
If the surgeon discovers any obstacles to the laparoscopic procedure, such as infection or scarring from other operations, the operating team may have to switch to open surgery.如果医生发现任何障碍，腹腔镜手术的程序，如感染或疤痕从其他业务，经营团队可能转向开放手术。 In some cases the obstacles are known before surgery, and an open surgery is planned.在某些情况下，障碍被称为在手术前和手术计划。 It is called "open" surgery because the surgeon has to make a 5- to 8-inch incision in the abdomen to remove the gallbladder.这就是所谓“开放式”手术，因为医生已使5 -8英寸切口在腹部，消除胆囊。 This is a major surgery and may require about a 2- to 7-day stay in the hospital and several more weeks at home to recover.这是一个重大的手术，可能需要约2 -7天的住院和几个星期在家恢复。 Open surgery is required in about 5 percent of gallbladder operations.开放手术需要约百分之五胆囊行动。
 The most common complication in gallbladder surgery is injury to the bile ducts.最常见的并发症在胆囊手术损伤胆管。 An injured common bile duct can leak bile and cause a painful and potentially dangerous infection.受伤的胆总管可胆汁泄漏，造成痛苦和具有潜在危险的感染。 Mild injuries can sometimes be treated nonsurgically.轻度伤害有时可处理nonsurgically 。 Major injury, however, is more serious and requires additional surgery.重大伤害，但是，更为严重的，并需要额外的手术。
 If gallstones are in the bile ducts, the physician (usually a gastroenterologist) may use endoscopic retrograde cholangiopancreatography (ERCP) to locate and remove them before or during the gallbladder surgery.如果结石在胆管，医生（通常是肠胃）可使用内镜逆行胰胆管造影（逆行胰胆管造影） ，以找到并删除它们之前或期间胆囊手术。 In ERCP, the patient swallows an endoscope--a long, flexible, lighted tube connected to a computer and TV monitor.在逆行胰胆管造影，病人燕子内窥镜-一个长期的，灵活的，灯火通明管连接到电脑和电视监控。 The doctor guides the endoscope through the stomach and into the small intestine.医生指导内窥镜通过胃进入小肠。 The doctor then injects a special dye that temporarily stains the ducts in the biliary system.医生然后注入特殊的染料染色暂时的导管中的胆道系统。 Then the affected bile duct is located and an instrument on the endoscope is used to cut the duct.然后，受影响的胆管位于和文书的内窥镜是用来切断术。 The stone is captured in a tiny basket and removed with the endoscope.石头是在抓获一个小篮子，并删除与内窥镜。
 Occasionally, a person who has had a cholecystectomy is diagnosed with a gallstone in the bile ducts weeks, months, or even years after the surgery.有时候，一个人谁了胆囊切除术是诊断为胆囊结石在胆管星期，几个月，甚至几年后的手术。 The two-step ERCP procedure is usually successful in removing the stone.这两个步骤逆行胰胆管造影程序通常是成功的，消除结石。
Nonsurgical Treatment 非手术治疗
Nonsurgical approaches are used only in special situations--such as when a patient has a serious medical condition preventing surgery--and only for cholesterol stones.非手术方法是只用于在特殊情况下-例如，当一个病人有严重的医疗条件防止手术-只为胆固醇结石。 Stones usually recur after nonsurgical treatment.滚石通常发生后，非手术治疗。
• Oral dissolution therapy. •口腔溶解疗法。 Drugs made from bile acid are used to dissolve the stones.药品从胆汁酸是用来溶解结石。 The drugs, ursodiol (Actigall) and chenodiol (Chenix), work best for small cholesterol stones.这些药物， ursodiol （ Actigall ）和chenodiol （ Chenix ） ，最适合小胆固醇结石。 Months or years of treatment may be necessary before all the stones dissolve.几个月或几年的治疗可能有必要在所有的石头解散。 Both drugs cause mild diarrhea, and chenodiol may temporarily raise levels of blood cholesterol and the liver enzyme transaminase.两种药物引起轻度腹泻， chenodiol可能会暂时提高各级血液中胆固醇和转氨酶肝酶。
• Contact dissolution therapy. •联系解散治疗。 This experimental procedure involves injecting a drug directly into the gallbladder to dissolve stones.这个实验过程中涉及的药物注射直接进入解散胆囊结石。 The drug--methyl tertbutyl ether--can dissolve some stones in 1 to 3 days, but it must be used very carefully because it is a flammable anesthetic that can be toxic.毒品-甲基叔丁基醚-可以溶解一些石头在1至3天，但它必须用非常认真，因为它是易燃的麻醉剂，可毒性。 The procedure is being tested in patients with symptomatic, noncalcified cholesterol stones.该程序正在测试患者的症状， noncalcified胆固醇结石。
• Extracorporeal shockwave lithotripsy (ESWL). •体外冲击波碎石（体外冲击波碎石术） 。 This treatment uses shock waves to break up stones into tiny pieces that can pass through the bile ducts without causing blockages.使用这种治疗冲击波打破石头成细小的碎片，可以通过胆管造成堵塞。 Attacks of biliary colic (intense pain) are common after treatment, and ESWL's success rate is not known.攻击胆绞痛（剧烈疼痛）是常见的治疗后，与体外冲击波碎石术的成功率是不知道。 This approach is usually combined with therapeutic ERCP.这种方法通常是结合逆行胰胆管造影治疗。
Don't people need their gallbladders? 不要人民需要他们的胆囊？
Fortunately, the gallbladder is an organ that people can live without.幸运的是，胆囊是一个机关，人民能够生活无。 Once the gallbladder is removed, bile flows out of the liver through the hepatic ducts into the common bile duct and goes directly into the small intestine, instead of being stored in the gallbladder.一旦去掉胆囊，胆汁流出肝脏的肝管进入胆总管，并直接进入小肠，而不是储存在胆囊。 However, because the bile isn't stored in the gallbladder, it flows into the small intestine more frequently, causing diarrhea in about 1 percent of people.然而，由于没有胆汁储存在胆囊，它流入小肠更加频繁，造成腹泻约为百分之一的人。
Points to Remember 记住要点
• Gallstones form when substances in the bile harden. •胆结石形成的物质时，胆汁中的硬化。
• Gallstones are more common among women, Native Americans, Mexican Americans, and people who are overweight. •胆结石比较常见的妇女，土著美国人，墨西哥裔美国人和人民谁超重。
• Gallstone attacks often occur after eating a meal. •胆结石经常发生袭击事件后，吃了一顿。
• Symptoms can mimic those of other problems, including heart attack, so accurate diagnosis is important. •症状能够模仿其他问题，包括心脏病发作，所以准确的诊断是非常重要的。
• Gallstones can cause serious problems if they become trapped in the bile ducts. •胆结石可能会导致严重问题，如果他们成为被困在胆管。
• Laparoscopic surgery to remove the gallbladder is the most common treatment. •腹腔镜手术切除胆囊是最常见的治疗。
Source: National Digestive Diseases Information Clearinghouse资料来源：国家消化系统疾病信息中心
Reviewed: March 2002综述： 2002年3月
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