Laparoscopic biliary stone extraction.
1.Epidemiological survey In recent years, with the development of China’s economy and the change of dietary habits, gallbladder stones, which have a high incidence in the West, have become a common clinical disease in China. According to the relevant statistics, the incidence rate of gallbladder stones in China is about 10% in adults and even 15% in middle-aged women.
2.Complications after gallbladder removal.
(1) Indigestion, bloating, diarrhea;
(2) reflux gastritis and esophagitis;
(3) Increased chance of common bile duct stones;
(4) Biliary complications after cholecystectomy;
(5) Potential risk of colon cancer, etc.
(6) Biliary tract injury
3.Gallbladder function
Combined with the complications after cholecystectomy, it is found that although the gallbladder is small, it has important digestive and immune functions and is not a dispensable organ.
4.What domestic experts have seen
(1) The late academician Qiu Fazu, a great leader in surgery, clearly stated in 2007 that we should pay attention to the function of gallbladder, play the role of gallbladder and protect the existence of gallbladder.
(2) Academician Huang Zhiqiang: “Should the gallbladder be removed in all cases of gallbladder stone disease?” “Is it reasonable to laparoscopically cut the gallbladder to prevent cancer?”
5. Data support
Prof. Zhang Baoshan introduced that more than 1,500 cases of endoscopic minimally invasive biliary stone extraction done by him, after 8-10 years of follow-up, the stone recurrence rate dropped to 1.99%~2.95%
6. Suggested indications for biliary stone extraction.
① Gallbladder stones. Good results of stone extraction with single stones;
②Gallbladder EF 70%.80%, with >75% preferred
③Gallbladder wall thickness ≤2 mm
④No gallbladder polyp-like lesions
⑤ No symptoms of gallstone disease and no complications.
Preoperative ultrasonography was performed to clarify the indications for surgery, and 20 cases of laparoscopic cholecystectomy were randomly selected after laparoscopic combined choledochoscopic lithotomy, and 20 cases of laparoscopic biliary stone extraction in this group, which were evaluated in 8 aspects of physiological function, physical function, somatic pain, general health status, energy, social function, emotional function, and mental health according to the simple health questionnaire designed by Boston University.
The assessment criteria 2, 4 and 8 weeks postoperative survey classified the physical recovery status into good, basic and poor according to the score; O-7 as good, 8-14 as basic and 15-21 as poor, the lower the score, the lighter the self-conscious symptoms of digestive tract, the better the physical recovery.