Symptoms such as severe abdominal pain, jaundice and fever caused by gallbladder or bile duct stones are called cholelithiasis, which is commonly referred to as gallstones. Gallstones can cause not only chronic inflammation of the gallbladder and bile ducts, but also malignant lesions of the gallbladder and bile ducts, which can even be life-threatening. Therefore, timely treatment is necessary.
Cholecystectomy is the most common and effective means of treating gallbladder stones. Among them, the minimally invasive laparoscopic cholecystectomy is less invasive and patients recover well after surgery, so it is gradually becoming the preferred surgical method. However, many patients have a fear of “gallbladder removal”. After learning of the surgery, they also consult multiple doctors: “Are there other treatments that can preserve the gallbladder?”
Wan Yunle, director of the Department of Hepatobiliary, Pancreatic and Splenic Surgery at the Sixth Hospital of Sun Yat-sen University, said that there are several treatments for gallstone disease other than surgery, but they cannot relieve the lesions. Here he will help patients analyze the pros and cons of various treatments in detail.
Q: Can bile be preserved?
Experts say: Currently, it is mostly not used.
Most patients with gallstones have abnormal gallbladder contraction, which is an important pathological basis for bile stasis and gallstone formation in the gallbladder. In addition, gallbladder stones damage the mucosa in the gallbladder for a long time, further aggravating the abnormalities of gallbladder contraction function. “Thus, even if short-term bile preservation is successful, it is inevitable that stones will recur again.” Wan Yunle said.
There are differences in the treatment of gallstones formed in different parts of the gallbladder or bile duct. Once extrahepatic bile duct stones are clearly diagnosed and symptomatic, it means surgery is needed: either traditional open surgery or minimally invasive surgery such as laparoscopic cholecystectomy, which aims to remove the lesion and establish unobstructed bile drainage.
Although the gallbladder is one of the six internal organs, it can and is recommended to be removed if it becomes diseased. The gallbladder mainly serves as a temporary storage, concentration and excretion of bile. After removal of the gallbladder, bile secretion is not significantly affected and the bile secreted by the liver can enter the intestine via the bile ducts.
The symptoms of intrahepatic bile duct stones are atypical. With the advancement of hepatic resection and hemostasis technology, hepatic segmental or lobectomy is gradually becoming the most ideal method to cure intrahepatic bile duct stones.
Q: Is extracorporeal lithotripsy effective?
Experts say: The efficacy is not yet clear
The efficacy of extracorporeal lithotripsy for gallstone disease is unclear and is not advocated because of the potential for serious complications. Under normal circumstances, the duodenal papilla is the narrowest part of the extrahepatic bile duct, and the passage of sediment-like stones or debris from the gallbladder through the duodenal papilla can easily become obstructed and cause biliary colic, jaundice, fever and other typical symptoms of bile duct obstruction, and even acute pancreatitis. And extracorporeal lithotripsy does not relieve the lesion of gallstone formation.
Q: Lithotripsy, is it reliable?
Experts say: It is not a substitute for surgical treatment
Lithotripsy is only used as a supplement to surgical treatment for gallstone disease. The drugs currently used for lithotripsy are only effective for cholesterol stones. They are not effective or largely ineffective for bile pigment or mixed stones. In addition, lesions of the gallbladder or bile duct itself that cause gallstone formation are not removed by lithotripsy.
Q: Do I need treatment if I have no symptoms?
Experts say: It depends on the individual case
Symptomatic gallbladder stones are an absolute indication for cholecystectomy (minimally invasive or open). Asymptomatic gallbladder stones can be observed and followed up, but active surgical treatment should be performed in cases where
1, gallbladder stones >2 cm in diameter, or multiple stones with stones <0.5 cm in diameter;
2, combined with surgery that requires open abdomen;
3, accompanied by gallbladder polyps >0.8cm;
4, thickening of the gallbladder wall;
5, calcification of the gallbladder wall or porcelain gallbladder;
6.Children with gallbladder stones;
7, need long-term parenteral nutrition or chemotherapy;
8, combined with diabetes mellitus;
9, with cardiopulmonary dysfunction;
10.Gallbladder stones found more than 10 years;
11, remote or underdeveloped transportation areas, field workers.
Symptoms alert to gallstone disease like stomach disease
The clinical diagnosis of cholelithiasis is not difficult when typical symptoms such as abdominal pain, fever and jaundice are manifested. However, gallstone is often misdiagnosed as “gastric disease” when it is asymptomatic or shows only certain atypical symptoms related to indigestion.
”Gallstone disease is usually pain in the upper abdomen or around the lowermost rib on the right side of the upper abdomen, and the pain radiates to the shoulder and back.” In addition to pain, patients can also have nausea, vomiting, fever, chills and other symptoms that can lead to jaundice and liver function damage, Wan Yunle said. He reminds that if symptoms similar to those mentioned above occur, it is important to seek medical attention in a timely manner.
The causes and mechanisms of gallstone formation are very complex, although they have not been completely clarified yet. Patients with viral hepatitis or cirrhosis, patients with obesity, hyperlipidemia, fatty liver, diabetes mellitus, and those with excessive fatty and sweet food are the high risk of gallstone disease.