Cholecystectomy has been used for more than 100 years as a treatment for benign gallbladder lesions such as cholecystitis, gallbladder stones and gallbladder polyps in recent medical practice. With the improvement of people’s living standard, the incidence of cholecystitis, gallbladder stones and gallbladder polyps has an obvious increasing trend. The incidence of gallbladder, gallbladder stones and gallbladder polyps has increased significantly.
A. The danger and symptoms of gallbladder stones
The majority of clinicians explain to patients that “gallbladder removal has no effect on the human body”, which gives many patients a piece of mind to accept this surgery. However, the gallbladder is not optional, it is a very important digestive organ and is an important part of the digestive system. Removal of the gallbladder can cause severe damage to the body, resulting in long-term indigestion and bloating and diarrhea, and many people who have had their gallbladder removed have poor tone and poor health due to long-term indigestion. Therefore, as long as possible, we should try to preserve the gallbladder; after gallbladder removal.
1, causing indigestion, bloating and diarrhea in human body.
2, cause alkaline reflux gastritis.
3.Increased incidence of common bile duct stones after cholecystectomy.
4.Incidence of colon cancer increases after cholecystectomy. Modern medical research shows that after cholecystectomy, the incidence of distant colorectal cancer is 45 times higher than that of normal people. The cholecystectomy procedure is very safe, and it is impossible to have those comorbidities of cholecystectomy, and there is no mortality rate so far. Minimally invasive fiberoptic choledochoscopic biliary stone extraction has been successfully carried out in our hospital and has achieved good results. It has brought good news to the friends with healthy gallbladder who have stones.
Second, the danger and symptoms of gallbladder stones
Cholecystitis and gallstones are common diseases. Most gallbladder infections occur due to the presence of stones in the gallbladder, which block the gallbladder duct and make the bile drainage poor, followed by bacterial infection and the formation of gallbladder inflammation. In some patients, there are no stones in the gallbladder, but bacteria enter the gallbladder from the intestine or from the blood circulation, resulting in cholecystitis. Patients with cholecystitis are also prone to the formation of gallstones due to changes in bile composition and concentration of bile with bacteria and inflammatory necrotic material as the core.
Therefore, cholecystitis and gallstones often exist together. If there are stones in the gallbladder or stones in the common bile duct that prevent the normal discharge of bile, the gallbladder will contract strongly, causing severe pain and even triggering the onset of cholecystitis or cholangitis. Some people with bacteria in the gallbladder can also develop the disease when the body’s resistance decreases. If treatment is not timely, the patient will have recurrent pain in the right upper abdomen, radiating to the back of the right shoulder, and in severe cases, nausea, vomiting, fever and even gallbladder perforation.
The “secret” of old-fashioned “gallstone extraction” is unveiled
Compared with the high-tech choledochoscope applied in the stone hospital, the old choledochostomy lithotomy is a blind lithotripsy, which is impossible to remove the stones; in addition, the process of lithotripsy is blindly using pliers and scrapers, which inevitably shreds the stones and misses the debris; when the fine stones grow slowly, it is mistaken for a “recurrence” of stones. “This is the key to the easy recurrence of choledochostomy after surgery. This is the key to recurrence after cholecystostomy.
New concept of gallbladder stone retrieval: In the past, whether it was gallbladder stones or gallbladder polyps, it was advocated to remove the gallbladder, believing that the gallbladder has no important function and is dispensable, and it is impossible to recur gallbladder stones or gallbladder polyps if the gallbladder is removed. However, the removal of the gallbladder can cause a series of adverse consequences in a considerable number of patients, which not only seriously traumatize the digestive system, but also scourge the immune system and endocrine system. The new endoscopic gallbladder surgery in Yunnan Stone Hospital is the true manifestation of minimally invasive.
In the past, the concept of minimally invasive only emphasized small incision, short operation time, small tissue damage and fast recovery. However, with the metamorphosis of the concept of minimally invasive, the concept of minimally invasive now attaches more importance to the preservation of the function of a healthy organ.
The important physiological functions of the gallbladder such as.
1. storage function.
2. contraction function.
3. concentration function.
4. secretion function.
5. immune function.
6, important influence on the digestive function.
7, has an important role in regulating the biliary fluid pressure, etc. gradually gaining attention.
Minimally invasive fiberoptic choledochoscopic lithotripsy preserves millions of functional healthy gallbladders, avoids heavy trauma to the digestive system, has no serious postoperative complications, and is less traumatic to the digestive, immune, and endocrine systems. Only a small incision is made at the base of the gallbladder, which is all the trauma to the digestive system. Moreover, the adverse effects on the immune system and endocrine system are not obvious.
Recent studies have concluded that immunosuppression due to surgical trauma is an important cause of increased chance of postoperative infection and tumor metastasis. Changes in the immune function status of the body after surgery are associated with the abnormal release of cytokines after the blow of surgery. The greater the surgical trauma, the greater the negative impact due to abnormal release of cytokines after surgery.
Relevant studies have proved that the changes in immune function after trauma and surgery in the organism due to inadequate preoperative psychological preparation, pneumoperitoneum, and surgical injury are manifested by changes in cellular and humoral immunity, among which changes in lymphocytes are dominant. A comparison of the above-mentioned response levels and a study of some endocrine hormones showed that laparoscopic surgery is significantly less damaging to the immune system than open surgery. In addition, the same results were obtained in experiments on the endocrine system for the same scientific purposes. In other words, laparoscopic surgery is much less traumatic than open surgery on all systems of the body.
New concept of minimally invasive fiberoptic choledochoscopy for biliary stone extraction
Before performing minimally invasive fiber choledochoscopy, the basic indications of surgery are strictly guaranteed, and adequate preoperative preparation is done. With the change of technology and equipment (such as the introduction of choledochoscope and neodymium laser), the problems of incomplete extraction of stones and whether the bile cyst duct is unobstructed after stone extraction are solved, which brings a “new life” to biliary stone extraction surgery.
The advantages of minimally invasive fiberoptic choledochoscopy for biliary stone extraction.
Highlight 1: Minimally invasive
This advanced technology only requires 3 (about 0.5-2cm) micro-incisions in the abdominal wall to avoid leaving long scars in the abdominal area of patients, which is less invasive, less painful, safe, and does not affect the beauty; the procedure is visualized and safe.
Highlight 2: Clear surgical field
With the help of high-tech products laparoscope and fiberoptic cholangioscope, the laparoscope is first inserted through abdominal puncture with a pneumoperitoneum needle to explore the position, appearance and whether there are adhesions of the gallbladder. The choledochoscope can be used to remove the gallbladder stones under the direct vision of the fiberoptic choledochoscope.
Highlight 3: Complete stone extraction
The use of fiberoptic choledochoscope overcomes the blind spot of the old choledochostomy; the latest special stone retrieval net is used instead of the past stone retrieval forceps, which can avoid the small stones left in the gallbladder or abdominal cavity caused by the stone retrieval forceps, so that the stone retrieval is complete and no sequelae are left. Finally, the choledochoscope was used to repeatedly check the gallbladder cavity for small stones and to observe the flow of bile into the gallbladder in order to exclude stones from being embedded in the gallbladder duct. After determining that there are no stones in the gallbladder, the gallbladder is carefully sutured in two layers with absorbable thread, and the surgical incision is finally closed layer by layer.
Highlight 4: Fast recovery
As patients suffer minimal trauma, they can get down to the ground and eat 1 day after surgery, and can be discharged after 3-5 days of hospitalization, which does not affect normal work and life, and also reduces the cost of treatment.
Highlight 5: Low recurrence rate
After the stone extraction is completed, the choledochoscope can clearly observe whether the gallbladder duct is open, which is the key to avoid stone recurrence.
VI. Which patients are suitable for biliary stone extraction
1, Patients with gallstones whose gallbladder ducts are patent.
2, patients with gallstones with normal gallbladder function.
3, patients with gallstones with mild inflammation of the gallbladder.
4.Patients with non-sedimentary stones, solitary stones or no more than two stones after examination, and the physician thinks that the operation can be performed.
7. Minimally invasive fiberoptic choledochoscopy for biliary stone extraction.
Minimally invasive fiberoptic choledochoscopy is a relatively advanced “biliary lithotripsy” operation, which is performed with the help of high-tech products laparoscopy and fiberoptic choledochoscope. The choledochoscope was inserted through an incision of about 0.5 cm at the bottom of the gallbladder, and the bile in the gallbladder was aspirated with a negative pressure suction device, while saline was put into the gallbladder cavity to make the surgical field clear.
Finally, the choledochoscope is used to repeatedly check whether there are small stones left in the gallbladder cavity and to observe the flow of bile into the gallbladder in order to exclude stone impaction in the gallbladder duct. After making sure that there are no stones in the gallbladder, the gallbladder is carefully sutured in two layers with absorbable thread, and the surgical incision is finally closed layer by layer.