About the current status of treatment of gallbladder stones

  The main treatment for gallbladder stones is surgery, although there is a wide range of methods, including lithotripsy, lithotripsy, lithotripsy and surgery. However, in recent years, there are two major controversial views on surgery, mainly between bile cutting and bile preservation. The theory of biliary excision for stone extraction was created by Dr. Langenbuch, a famous German doctor, in 1882. In the absence of endoscopic technology, he proposed that “cholecystectomy should be performed not only because the gallbladder contains stones, but also because the gallbladder can grow stones. ” This is the famous “hotbed doctrine”, which has been regarded as “holy writ” and “gold standard” for more than 100 years. After removal of gallbladder, there is no possibility of recurrence of gallbladder stones; however, the risk of increased incidence of common bile duct stones has been raised; however, the clinical risk of common bile duct stones is much higher than that of gallbladder stones. With the progress and development of science and technology in recent years, a large number of clinical reports on various maladies after cholecystectomy have revealed that the gallbladder has complex and extremely important functions that are indispensable and irreplaceable. The gallbladder is a very important digestive and immune organ of the human body and has the role of regulating the pressure in the bile ducts inside and outside the liver and maintaining the balance of fluid mechanics in the bile ducts. In recent years, many European scholars found a phenomenon and doubt that among cases suffering from colon cancer, many cases were found to have a history of gallbladder removal. Moorehead analyzed 100 cases of biliary excision and 100 cases of non-biliary excision over 60 years old and found that those suffering from colon cancer were 12:3 respectively. It is generally believed about the mechanism of promoting colon cancer after cholecystectomy: more bile after cholecystectomy circulation affects the degradation of bacteria, and the resulting increase in the content and proportion of secondary bile acids in the bile salt pool, which has carcinogenic or synergistic carcinogenic effects and therefore predisposes to colon carcinogenesis.  Regarding the issue of recurrence, with the development of endoscopic science, direct biliary endoscopy for biliary stone extraction is safe and reliable, avoiding “missed gallstones” during cholecystostomy and reducing the false positives of recurrence. Nevertheless, recurrence of stones after choledochotomy is still the key to the full implementation of this procedure, and the presence of factors associated with stone formation makes recurrence possible. Recurrence rates of less than 10% have been reported with endoscopic biliary stone extraction, but they are not supported by more extensive scientific clinical studies. In a follow-up of 792 patients whose stones had disappeared under conservative treatment at Shanghai Zhongshan Hospital, the recurrence rates were 11.6%, 22.3%, 24.5%, 36.4%, 39.3%, and 39.6% for gallstones at 1, 2, 3, 4, 5, and more than 5 years, respectively. (Huang Jiaji Surgical Sciences, 7th edition, p. 1799). However, long-term use of this drug has strong side effects and serious damage to the liver, and it cannot solve the problem of recurrence. The reason for the formation of gallstones is the variation of bile composition, which is manifested by the relatively low content of bile acid salts and excessive cholesterol and bilirubin. Later, cholesterol and bilirubin will gradually precipitate out and coalesce into stones, and the drug cannot solve the root cause of stone formation.  The formation of gallbladder stones is mainly related to the contractile function of the gallbladder, the inflammation of the gallbladder wall (manifested as the thickness of the wall) and the composition of the bile. As the contractile function of the gallbladder is weakened, resulting in delayed emptying, bile retention and stagnant deposits can form stones. On the contrary, if the contractile function of the gallbladder is good, even if small cholesterol crystals or calcium bilirubin precipitates are formed due to various reasons, these formed components can be removed from the gallbladder in time to prevent further enlargement of these substances in the gallbladder to form stones, thus interrupting the process of gallbladder stone formation. The inflammatory thickening of the gallbladder wall increases the absorption of bile salts by the mucosa, resulting in a decrease in the concentration of bile salts in the bile and easy precipitation of cholesterol crystals on the supersaturated surface. It can be seen that the treatment of inflammation of the gallbladder wall and the restoration of the contractile function of the gallbladder as soon as possible after stone extraction are very important and are the key measures to prevent the recurrence of stones.