Gallstone disease is a common clinical disease, according to the location of the stone is divided into gallbladder stones, common bile duct stones, common hepatic duct stones and intrahepatic bile duct stones, the incidence of gallstone disease in China is about 7%, and increases with age, the ratio of men to women is about 1:2, the peak age of incidence is 50-60 years old, the main risk factors for gallstone disease are age, gender, diet and obesity, genetic inheritance is also a risk factor.
In general, gallstone can be diagnosed by ultrasound, CT or MRI of the abdomen. If left untreated, it can lead to recurrent cholecystitis, cholangitis, acute biliary pancreatitis, impaired liver function and gallbladder cancer.
The most common gallstone disease is gallbladder stones, and the main symptoms are.
(1) Recurrent episodes of vague pain, distension or right back discomfort in the right upper abdomen and subxiphoid process, which may be accompanied by nausea and vomiting, acid reflux, etc., often misdiagnosed as “stomach disease”.
②Symptoms of dyspepsia, which are obvious after eating fatty food.
(3) May or may not have a history of biliary colic, manifested as an attack of right upper abdominal colic, radiating to the right shoulder and back, lasting from several minutes to several hours.
④It may also be asymptomatic and only detected during ultrasound examination.
Physical signs
In acute attacks without inflammation, there may be no signs, or only pressure pain in the right upper abdomen without muscle tension and rebound pain; in cases of stone impaction or with acute inflammation, there may be symptoms of biliary colic, muscle tension and rebound pain in the right upper abdomen. In case of enlarged gallbladder, it may be palpable under the right rib cage and may be accompanied by chills, fever, yellow sclera and percussion pain in the liver area.
Treatment principles
The treatment includes surgical and non-surgical treatment. Once gallbladder stones are diagnosed, early surgical treatment is recommended. The treatment of bile duct stones is based on the principle of removing stones, relieving obstruction and clearing drainage.
Surgical approach
It is important to consider not only the thoroughness of the surgery, but also the safety of the patient.
Laparoscopic cholecystectomy: It has the same efficacy as the classical open cholecystectomy, but with less pain, faster recovery and shorter hospital stay, and is suitable for most patients. It should be used with caution when combined with acute cholecystitis, and is not recommended when combined with gallbladder perforation, internal gallbladder fistula and suspected gallbladder cancer.
②Open cholecystectomy: it is still the common method for treating this disease.
③If gallbladder gangrene or adhesions are serious, resection is difficult, or the patient’s general condition is poor and cannot tolerate surgery, gallbladder lithotomy should be performed.
④In some cases, such as the patient is young, the gallbladder contraction function is normal, and the bile duct is open, etc., the lithotomy with preservation of the gallbladder can be considered.
⑤ If complicated by bile duct stones or cholangitis, bile duct extraction, bile duct drainage or endoscopic lithotripsy treatment should be performed.
Non-surgical treatment methods
It mainly refers to anti-inflammatory and antispasmodic treatment, which aims to relieve the symptoms of patients with acute inflammation and later elective surgery.