1.What are the causes of gallbladder stones?
The causes of gallbladder stones are very complex and are due to a combination of factors. Currently, it is believed that the basic factor is the change of the composition and physicochemical properties of bile. The function of the gallbladder is mainly to store, concentrate and discharge bile. The secretion of bile is continuous, but the discharge of bile is continuous with feeding, which is achieved by contraction of the smooth muscle of the gallbladder and relaxation of the sphincter of Oddi at the end of the common bile duct. Most of the bile is water, and three other major lipids are bile acids, cholesterol and phospholipids, which interact with each other to promote the dissolution and excretion of cholesterol in the bile. When the human body consumes too much cholesterol, the cholesterol in the bile secreted by the liver becomes saturated and easily precipitates and crystallizes to form stones. In addition, there may be a nucleation factor in the bile of gallbladder stone patients, which can secrete a large amount of mucus glycoprotein to promote nucleation and stone formation. In addition, the contraction ability of the gallbladder is reduced, and the bile in the gallbladder is concentrated to form bile sludge, which is also conducive to stone formation.
2.What are the symptoms of gallbladder stone patients?
The symptoms of gallbladder stones depend on the size and location of the stones, as well as the presence of obstruction and inflammation. In the early stage, there is often no specific symptom, sometimes it is a slight discomfort of right upper abdominal fullness, which is often mistaken for “stomach disease” and not diagnosed in time. About 40% of patients with gallbladder stones are asymptomatic for life, i.e., the so-called quiescent gallbladder stones. Symptomatic gallbladder stones are mostly manifested as indigestion symptoms such as hidden pain in the upper abdomen and fullness after eating fatty foods. When eating greasy food gallbladder contraction, or sleep position change, resulting in stones embedded in the gallbladder duct caused biliary colic and acute cholecystitis, mainly manifested as right upper abdomen or epigastric paroxysmal colic, accompanied by nausea and vomiting.3, smaller stones may also enter the common bile duct through the cystic duct and occur obstructive jaundice, and may stay in the bile duct as secondary bile duct stones.
3.How to treat gallbladder stones?
At present, there are more methods to treat gallbladder stones, but surgery is still the main treatment.
(1) Surgical treatment.
Laparoscopic cholecystectomy is currently the most widely used surgical procedure. However, in recent years, minimally invasive endoscopic biliary stone removal surgery has been carried out in China, which mainly involves the application of choledochoscope to completely remove the stones in the gallbladder during the operation and preserve the gallbladder. In 2003, after summarizing the experience of small incision minimally invasive endoscopic biliary lithotripsy, Jingqiang Zhou et al. used the advantages of minimally invasive techniques such as laparoscopy and cholangioscopy to combine laparoscopy and cholangioscopy for patients with gallbladder stones with good contractile function and physiological status. In patients with good contractile function and physiological status of the gallbladder, the gallbladder can be removed through two to three holes in the abdominal wall of 0.5-1.0 cm, while preserving the gallbladder. The study was evaluated by experts in 2008 and reached the international advanced level.
Its advantages are.
1.Use of laparoscopic wide field of view, optimize the selection of indications; can be corrected under the microscope, such as the neck of the gallbladder, ducts tortuous angle and other difficult stone extraction, to ensure the net rate of stone extraction and stone extraction effect, reduce the recurrence rate.
2. No incision, no suture, suture removal, light abdominal adhesion, small trauma, fast recovery and short hospitalization time. The patient’s body temperature, white blood cells and other vital signs fluctuate less after surgery, which is difficult to be achieved by other surgeries. 3, less complications. At present, hundreds of cases of laparoscopic biliary lithotripsy have been performed, and the cure rate has reached 100% without any complications. It greatly reduces the pain of patients and is welcomed by the majority of patients. For some patients with poor gallbladder function, heavy inflammation of gallbladder wall or gallbladder atrophy caused by long-term gallbladder stones, single or three-hole laparoscopic cholecystectomy is performed, which is less traumatic, less painful, quicker recovery, and very safe with exact results, and the possibility of recurrence of gallbladder stones is fundamentally removed because the lesion is removed.
(2) Lithotripsy treatment
The main mechanism of gallbladder stone formation is the change of bile physicochemical composition, the decrease of bile acid and phospholipid, and the increase of cholesterol concentration. Currently, oral administration of goose deoxycholic acid or ursodeoxycholic acid increases the pool of bile acids and reduces cholesterol, thus turning the cholesterol in the gallbladder to a non-saturated state and lithotripsy, but patients need to take the drug for a long time, and half of the people will have a recurrence of stones after stopping the drug. Lithotripsy is mostly used for cholesterol stones that are small and can be transmitted by X-rays; at present, there are still some limitations of such lithotripsy treatment. In addition, there are oral herbal lithotripsy treatments. The main function of herbal medicine is to reduce inflammation and bile, control symptoms and reduce biliary colic attacks; only for a very small number of patients is it possible to achieve the effect of lithotripsy; there is no evidence yet that herbal medicine can dissolve gallstones.
(3) Extracorporeal shock wave lithotripsy
Extracorporeal shock wave lithotripsy was first used to treat urinary stones, and later was used to treat gallstones, but the composition of gallbladder stones is different from urinary stones, while the urinary system is completely different from the biliary system, which makes its still poor stone removal effect, and the high recurrence rate of stones and expensive treatment have limited its application.
4.How to prevent gallbladder stones?
Most of gallbladder stones belong to cholesterol stones, which may be related to nutritional diet and body metabolism. Domestic and foreign data show that in the population with low economic income and lack of protein and fat in the diet, the incidence of bile duct stones, mainly bile pigment stones, is high, while the rich urban residents, as well as the population in economically developed countries, have more protein and fat in the diet, and the incidence of gallbladder stones, mainly cholesterol, is high. The incidence of cholesterol-based gallbladder stones is high. In order to prevent the occurrence of gallstone disease food should be meat and vegetarian mix, eat protein and fat to moderate, increase the fiber content of food, coarse and fine grains with, do not eat or eat less cholesterol content of food. To advocate a full breakfast, do not avoid not eating in the morning, because breakfast fasting people with high cholesterol saturation in the bile. Advocate eating vegetable oil properly to facilitate gallbladder contraction and emptying. Actively treat diseases that are likely to cause stones, such as obese people should lose weight, and diabetic people should actively treat and control diabetes, etc.
5, gallbladder stones are prone to several misconceptions in the understanding
Myth 1: Gallbladder stones are not painful and do not need surgery, wait until recurrent pain occurs and then operate. This is a misconception, and this misconception has caused a considerable number of patients great pain, irreparable damage and even the cost of life. In fact, the need for treatment of gallbladder stones cannot be determined only by the clinical presence of pain, but must be judged by the size and number of stones, the age of the patient, and the presence of combined diabetes. For example, multiple gallbladder stones, regardless of their current symptoms, have a 100% chance of developing symptoms in the future and are prone to complicate acute pancreatitis and even lead to gallbladder malignancy. Another example is that gallbladder stones larger than 2 cm in diameter have a much higher chance of developing gallbladder cancer. Another example is that gallbladder stones in diabetic patients are more likely to be symptomatic and may become aggressive cholecystitis if they attack. Therefore, it is a misconception to decide whether to operate or not based on pain alone.
Myth 2: Gallbladder stones can be removed by herbal medicine, meridians, or by laser or shock wave lithotripsy. This concept is also unscientific. Because the human gallbladder is connected to the common bile duct through the cystic duct, the diameter of the cystic duct is generally less than 2mm, and the mucous membrane of the cystic duct is spirally protruding in the lumen of the cystic duct, so it is almost impossible for gallbladder stones to be discharged through such a slender cystic duct. The majority of Chinese gallbladder stones are of mixed type, and there is no medicine that can completely dissolve or dissolve the stones with certainty. There is also no equipment that can effectively break up the stones. Therefore, it is a misconception to believe that herbs, meridians, laser and shock waves can drain and break stones.
Myth 3: It is enough to take medication for gallbladder stones that are not too painful, and then operate when the pain is too severe. In fact, this is also a misconception. At present, the treatment of gallbladder stones has been completely minimally invasive, and the treatment process is almost painless and recovery is fast. However, if you wait until the gallstones are recurring, or even suppurating, with severe adhesions, atrophy, or mechanization, minimally invasive treatments are often unable to help, and you have to operate. This concept often complicates the treatment of easily treatable gallstones and makes it very difficult to deal with them, and naturally, the patient’s pain is greatly increased.