在欧美地区,胆石症在成年人中的发病率大概是 10-15%。[3]Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver. 2012 Apr;6(2):172-87.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3343155/pdf/gnl-6-172.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/22570746?tool=bestpractice.com 美洲印第安人群的胆石症患病率最高;西班牙裔人群患病率较低。[4]Everhart JE, Yeh F, Lee ET, et al. Prevalence of gallbladder disease in American Indian populations: findings from the Strong Heart Study. Hepatology. 2002 Jun;35(6):1507-12.http://www.ncbi.nlm.nih.gov/pubmed/12029637?tool=bestpractice.com 年龄、肥胖和雌性性激素是重要的致病因素。[3]Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver. 2012 Apr;6(2):172-87.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3343155/pdf/gnl-6-172.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/22570746?tool=bestpractice.com[5]Sun H, Tang H, Jiang S, et al. Gender and metabolic differences of gallstone diseases. World J Gastroenterol. 2009 Apr 21;15(15):1886-91.http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=19370788http://www.ncbi.nlm.nih.gov/pubmed/19370788?tool=bestpractice.com 非洲和亚洲发病率相对低。[6]Shaffer EA. Gallstone disease: epidemiology of gallbladder stone disease. Best Prac Res Clin Gastroenterol. 2006;20(6):981-96.http://www.ncbi.nlm.nih.gov/pubmed/17127183?tool=bestpractice.com 目前,肥胖促使结石发病率逐渐增加毋庸置疑。
尽管胆石症患病率很高,但通常>80% 的患者无症状。[7]Attili AF, Carulli N, Roda E, et al. Epidemiology of gallstone disease in Italy: prevalence data of the Multicenter Italian Study on Cholelithiasis (M.I.COL.). Am J Epidemiol. 1995 Jan 15;141(2):158-65.http://www.ncbi.nlm.nih.gov/pubmed/7817971?tool=bestpractice.com 然而,之前无症状的患者中每年有 1-2% 出现胆源性腹痛。[8]Freidman GD, Raviola CA, Fireman B. Prognosis of gallstones with mild or no symptoms: 25 years of follow-up in a health maintenance organization. J Clin Epidemiol. 1989;42(2):127-36.http://www.ncbi.nlm.nih.gov/pubmed/2918322?tool=bestpractice.com[9]Gracie WA, Ransohoff DF. The natural history of silent gallstones: the innocent gallstone is not a myth. N Engl J Med. 1982 Sep 23;307(13):798-800.http://www.ncbi.nlm.nih.gov/pubmed/7110244?tool=bestpractice.com[10]McSherry CK, Ferstenberg H, Calhoun WF, et al. The natural history of diagnosed gallstone disease in symptomatic and asymptomatic patients. Ann Surg. 1985 Jul;202(1):59-63.http://www.ncbi.nlm.nih.gov/pubmed/4015212?tool=bestpractice.com 一旦发生胆绞痛,约 50% 患者将继续出现复发性疼痛,同时多达 3% 的患者的并发症风险增加,并发症包括急性胆囊炎、胆管炎或急性胰腺炎。对于有结石的无症状患者,每年也有 0.1-0.3% 会出现严重并发症。[10]McSherry CK, Ferstenberg H, Calhoun WF, et al. The natural history of diagnosed gallstone disease in symptomatic and asymptomatic patients. Ann Surg. 1985 Jul;202(1):59-63.http://www.ncbi.nlm.nih.gov/pubmed/4015212?tool=bestpractice.com[11]Friedman GD. Natural history of asymptomatic and symptomatic gallstones. Am J Surg. 1993 Apr;165(4):399-404.http://www.ncbi.nlm.nih.gov/pubmed/8480871?tool=bestpractice.com 这些并发症使胆囊结石成为美国最常见的需要住院治疗的胃肠道疾病,每年大概要做 700,000 台胆囊切除术。[12]National Institutes of Health Consensus Development Conference Statement on Gallstones and Laparoscopic Cholecystectomy. Am J Surg. 1993 Apr;165(4):390-8.http://www.ncbi.nlm.nih.gov/pubmed/8480870?tool=bestpractice.com