1.What should I do if gallbladder stones are found during physical examination?
This group often belongs to the “asymptomatic gallbladder stones” or those with mild symptoms, and the gallbladder function is often normal in this group, so it is especially important to preserve the gallbladder.
At present, due to the maturity and development of biliary endoscopy technology, minimally invasive endoscopic techniques can be used to remove the stones and preserve the gallbladder with less pain, less trauma, shorter hospital stay (3-4 days after surgery) and faster recovery, and the cost is comparable to laparoscopic cholecystectomy and open cholecystectomy. More importantly, it preserves the gallbladder with normal function and avoids a series of complications after gallbladder removal.
2.What is asymptomatic gallbladder stone? Do they also need surgery? Is it possible without surgery? Can we use the method of preserving the gallbladder?
Asymptomatic gallbladder stones are found incidentally during physical examination, surgery, autopsy or other tests, and are called “resting gallbladder stones” or “asymptomatic gallbladder stones”. In the past, it was thought to be under observation and no treatment was needed. However, a lot of clinical data show that long-term gallbladder stones can easily lead to gallbladder cancer, especially in female patients. At present, the biliary endoscopy technology can adopt the minimally invasive method of “removing stones and preserving gallbladder”, so that patients can avoid the pain of gallbladder removal.
3.What are gallbladder stones?
Gallbladder stones are mainly cholesterol stones or cholesterol-based mixed stones, mainly found in adults, women are more common, especially in menstruating mothers and those taking contraceptive drugs, the ratio of men to women is about 1:3, and the ratio of men to women at the age of 50 is about 1:1.5. The incidence of men and women in the elderly is basically equal, which may be related to the role of estrogen in the formation of gallbladder stones.
4.What are the symptoms of gallbladder stones?
About 20-40% of patients can be asymptomatic for life, but are found incidentally during physical examination, surgery, autopsy or other examinations, which is called “resting gallbladder stones” or “asymptomatic gallbladder stones”.
Symptomatic gallbladder stones are mainly manifested as
Gastrointestinal symptoms such as dyspepsia: after eating, especially after eating fatty food, the upper abdomen or right upper abdomen may cause vague pain and discomfort, fullness, belching, acid reflux, and erratic flow, which are often mistaken for “stomach disease”.
Biliary colic is the typical manifestation: it is what we usually call “biliary pain” and often occurs after a full meal, after eating fatty foods, or during sleep. The pain is located in the upper abdomen or right upper abdomen, is paroxysmal, and may radiate to the shoulder blade and back, mostly accompanied by nausea and vomiting.
5.How to prevent the occurrence of gallbladder stones?
With the accelerated pace of modern life and increased work pressure, the incidence of gallbladder stones has increased significantly in more and more people, especially young people, and how to prevent it is especially important. At present, it is not possible to prevent gallbladder stones by controlling a certain link because the mechanism of their occurrence is not very clear, but a good diet and a healthy diet is a good way to prevent them, with three regular meals and less food containing high cholesterol such as animal offal. Breakfast is especially important, the morning meal contains protein, moderate amount of fat (such as milk, eggs, bread, etc.) to help the discharge of concentrated bile in the gallbladder, timely replacement of fresh bile, to avoid the deposition of bile and chemical stimulation of the gallbladder, thereby preventing the occurrence of stones.
6.Can gallbladder stones be treated well with medication?
However, these drugs are only suitable for cholesterol stones, but at present, the instrument can not check the nature of the stones accurately, and these drugs have hepatotoxicity, big reaction, long taking time, expensive, and the stones recur after stopping the drugs.
7.What is gallbladder polyp?
Gallbladder polyp is a morphological name for a lesion that protrudes or bulges into the lumen of the gallbladder, either spherical or hemispherical, with or without a tip, mostly benign, with cholesterol polyps being the most common.
Most of this disease is found by ultrasound during physical examination, asymptomatic, individual with right upper abdominal discomfort, pain, nausea, etc., but these are often caused by cholecystitis rather than gallbladder polyps.
8.Does gallbladder stone have to be removed? What kind of gallbladder stones need to be removed? What kind of gallbladder can be preserved?
(1) For patients with gallbladder stones of normal size, shape and function, the method of “endoscopic minimally invasive biliary stone extraction” should be used.
(2) For gallbladder with atrophy, thick wall (>0.5cm), non-functional gallbladder, suspected cancer, or cancerous gallbladder, gallbladder should be removed.
9.What about gallbladder polyps found in physical examination?
Most of the gallbladder polyps are benign, cholesterol polyps are common, adenoma is one of them, but its incidence is very low, the proportion in the gallbladder resection specimens is only 1.1%, the malignant rate is 1.5%, it is considered pre-cancerous lesions of gallbladder, so gallbladder polyps malignant is rare, clinical concern is easy malignant change of polyps, the current detection means is not yet able to determine the nature of polyps, so It appears that the size of the gallbladder polyp is used to determine whether surgery should be performed. However, the size of the diameter of gallbladder polyps alone is a vague and unscientific criterion for determining whether the gallbladder should be removed. Most of the gallbladder polyps are cholesterol polyps, which are benign, and it is not scientific to perform cholecystectomy for all benign lesions.
For the sake of protecting gallbladder function and avoiding long-term complications after cholecystectomy, cholecystectomy may not be performed for all gallbladder polyps.
For cases of gallbladder polyps, the method of “endoscopic minimally invasive biliary polyps removal” is feasible, and the recurrence rate is only 1%. This avoids most benign polyps from suffering the fate of gallbladder removal. This method is based on the pathological nature of gallbladder polyps to decide whether to remove the gallbladder, and is considered to be the most reasonable and scientific treatment method in the biliary surgery clinic.
10.What is the function of gallbladder? Is it an organ that can be removed at will?
In the past, the function of gallbladder was not well understood, except for its function of concentration and contraction, it was only a storage organ for bile, which was not valued and even considered dispensable. Therefore, gallbladder removal was not a matter of debate. 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 and is indispensable and irreplaceable. With the modern medical exhibition, there is a further understanding of the gallbladder as an important digestive organ, which is a complex organ of chemical and immunological functions, in addition to its role of concentration, contraction and regulation of buffering biliary pressure. It is not a dispensable gallbladder, but a very important digestive organ, so it should not be easily abolished! Of course, for those who have an atrophied gallbladder, whose gallbladder is no longer functional, or whose gallbladder is suspected to be cancerous, the gallbladder should undoubtedly be removed to remove the lesion.
11.What are the hazards of gallbladder removal to human body?
The side effects or bad effects after cholecystectomy should be paid great attention to, which directly affects the quality of life of the patient and even endangers the patient’s life. What is the harm to human body after gallbladder removal?
(1) Indigestion, bloating and diarrhea As far as we know, the gallbladder has at least the function of storage, concentration and contraction. Of course, it also has complex chemical and immune functions. If the gallbladder has been removed, there is no place to store the bile discharged from the liver, whether the body needs it or not, so it has to be continuously discharged into the intestines; when we go to a banquet to eat thick sorghum, we need a lot of bile to help digestion, but unfortunately, there is no “spare food” in the body to help, so the body has to suffer from indigestion, bloating and diarrhea
(2) Gastric reflux of duodenal fluid after cholecystectomy.
After cholecystectomy, the loss of bile reserve function after cholecystectomy causes the bile to be excreted into the duodenum continuously from intermittent and feeding-related excretion, which increases the chance of reflux into the stomach. This leads to bile reflux gastritis or esophagitis, which brings a lot of pain to the patient.
(3) The effect of cholecystectomy on the incidence of colon cancer The risk of colon cancer after cholecystectomy is 45 times higher than that of cases without cholecystectomy.
(4) The problem of bile duct injury after cholecystectomy is inevitable and there is always a certain probability of comorbidities brought about by cholecystectomy; and there is a certain mortality rate; including: bile duct injury, liver duct injury, vascular injury, gastrointestinal injury, etc. After cholecystectomy, the gallbladder loses its buffering effect on the fluid pressure in the bile duct, resulting in higher pressure in the common bile duct, which causes compensatory dilation of the common bile duct, thus slowing down the bile flow in the common bile duct. and vortex or eddy flow occurs, the latter being an important doctrine for the formation of gallstones. In this way, cholecystectomy for gallbladder stones avoids the risk of “recurrence” of gallbladder stones after surgery, but invites the scourge of “growing common bile duct stones”; which stones are the most dangerous? It is self-evident which is more important.
12. What is the difference between minimally invasive endoscopic cholecystectomy and cholecystectomy?
Regarding the treatment of gallbladder stones, there is a world of difference between biliary preservation and cholecystectomy. Endoscopic biliary preservation preserves the physiological function of the gallbladder; cholecystectomy loses the gallbladder and its physiological function, which can cause a series of physiological disorders and even the possibility of colon cancer; the recurrence rate of gallbladder stones after cholecystectomy is not high (1-7%), which has been uncovered and confirmed by modern clinical practice. Gallbladder stone extraction is very safe, and it is impossible to have those comorbidities of gallbladder removal.
After removal of the gallbladder, of course, there is no possibility of recurrence of gallbladder stones; however, the risk of increased incidence of common bile duct stones is increased; however, the clinical risk of common bile duct stones is much greater than that of gallbladder stones, so which one is cost-effective?
With the development of modern medical science and technology, there is a better understanding of the gallbladder as an important digestive organ, which is a complex organ with chemical and immunological functions, in addition to its role in concentrating, contracting and regulating the pressure of the buffered bile duct. It is not a dispensable gallbladder, but a very important digestive organ, so it should not be easily abolished! Of course, for those who have an atrophied gallbladder, a non-functional gallbladder, or a suspected cancerous gallbladder, the gallbladder should undoubtedly be removed to remove the lesion.
13.How to treat hepatobiliary stones minimally invasively with cholangioscopic technology?
Traditional surgical methods for hepatobiliary stones have a postoperative incidence of residual stones as high as 30%-90% and are very blind and limited, which can cause complications such as bile duct injury, bile duct bleeding, sphincter of Oddi and duodenal injury. Intraoperative and postoperative use of choledochoscopy is of great value in improving the efficacy of hepatobiliary stones and can result in a significant decrease in the residual stone rate of bile duct stones. Intraoperative choledochoscopic stone extraction not only visualizes the lesions of the bile ducts, but also provides guidance for the selection of the surgical procedure for intrahepatic bile duct stones.
The value of intraoperative choledochoscopy is that the whole picture of the intra- and extrahepatic bile ducts can be observed, stones can be retrieved under direct vision of the choledochoscope, and for larger embedded stones, plasma noninvasive lithotripsy can be used. The use of choledochoscopy technology can improve the results of surgical procedures such as extrahepatic choledochotomy, drainage and bile-intestinal anastomosis, which are still commonly used.
14.What should I do if I have “residual bile duct stones” after surgery?
For patients with T-tube, choledochoscopic extraction via T-tube fistula is performed 4-6 weeks after surgery, without anesthesia and re-operation, which is less painful and less traumatic. Transcholangioscopic stone extraction and lithotripsy is the follow-up treatment for residual and/or recurrent stone treatment in the hepatobiliary duct, and the stone removal rate can be as high as 97%-99%.
15.What is “endoscopic minimally invasive biliary lithotripsy” and how is it different from “old-fashioned biliary lithotripsy”?
Endoscopic minimally invasive biliary lithotripsy is another new contribution of choledochoscopy technology to gallbladder stone treatment, which is a new theory, new concept and new development in gallbladder stone treatment. Since the choledochoscope can enter the gallbladder for direct visual inspection, it can really ensure whether the stones are removed from the gallbladder, which is very accurate.
When he was treated with choledochostomy alone (hereinafter referred to as old-fashioned cholecystectomy), he found that gallbladder stones were very easy to recur after surgery, and the recurrence rate was 80%-90%. The importance of gallbladder function is ignored.
Preserving the gallbladder and removing it have very important effects on the human body. After cholecystectomy, the physiological balance of the body is greatly affected, reflecting the importance of the gallbladder function, which should not be removed at will but should be protected by all means.