Gallstone disease in China has been on the rise in recent decades, and the relative incidence of gallbladder stones has accounted for 70% to 80% of gallstone disease. However, 20% to 40% of patients with gallbladder stones can be asymptomatic for life. The question of whether prophylactic cholecystectomy should be performed in these clinically asymptomatic gallbladder stone patients has been troubling.
Gallbladder stones may become gallbladder cancer
With the advances in modern imaging, this issue has become of particular concern. Because asymptomatic gallbladder stones present a benign natural course and routine autopsy data show that about half of all gallbladder stone patients are asymptomatic during life, there are many advocates for not performing prophylactic cholecystectomy. However, other studies have shown that there is a close relationship between gallbladder cancer and the occurrence of gallbladder stones. It is believed that gallbladder stones are a precancerous lesion of gallbladder cancer, and 70% to 80% of gallbladder cancers are associated with stones.
It has been pointed out that the risk of gallbladder cancer for patients with gallbladder stones is 6-15 times higher than that for those without stones, and there is also a close relationship between the size of stones and the incidence of gallbladder cancer. 40% of gallbladder cancer patients have stones larger than 3 cm, 12% have stones smaller than 1 cm, and the risk of gallbladder cancer is 10 times higher for those with a diameter of 3 cm or more than 1 cm. Long-term gallbladder stones often cause gallbladder atrophy and calcification, and among patients with calcified gallbladder or porcelain-like gallbladder, 20% to 60% of them have gallbladder cancer.
Recent studies also show that the incidence of gallstone disease in the elderly in China is 8% to 10%, and the incidence increases with age, and the incidence of gallbladder stones in the elderly over 80% can reach 23%. The incidence of acute cholecystitis is significantly higher in diabetic patients with gallbladder stones, ranging from 13% to 16%, and the mortality rate will increase fivefold once complications occur. Most gallbladder stones in children are associated with certain susceptibility factors, such as hereditary spherocytosis, which not only results in hemolytic anemia but also gallstone disease, the incidence of which increases with age. Its incidence increases with age. 50% of its patients over 20 years of age have gallstone complications.
Removal of the gallbladder is recommended in patients with asymptomatic gallbladder stones
In summary, although asymptomatic gallbladder stones are not obviously uncomfortable, they are not harmless, but it is still difficult to make an early diagnosis of the risk to human beings. Once obvious discomfort occurs, it is often life-threatening, so some people advocate preventive cholecystectomy. Because the benefits of removing a potentially cancerous gallbladder are supposedly greater than the risks of surgery.
It has also been argued that gallbladder removal is not only due to the presence of stones in the gallbladder, but that a gallbladder with stones is also a site of complications of gallbladder cancer. Since 1882, when total cholecystectomy was first performed, cesarean cholecystectomy has been the only standard procedure for the treatment of gallbladder stones. Nowadays, laparoscopic cholecystectomy is widely performed at home and abroad, which has the advantages of less trauma, less pain, faster recovery, safety, and fewer complications, and has the potential to replace the traditional cholecystectomy.
Cholecystectomy must be strictly controlled for indications
At present, domestic and foreign scholars believe that elective cholecystectomy is feasible for asymptomatic gallbladder stones in one of the following cases.
1, middle-aged and elderly female patients with gallbladder stones.
2. Long duration of the disease, with a history of gallbladder stones of more than 5 years.
3, Patients with gallbladder stones with ultrasound suggesting limited thickening of the gallbladder wall or porcelain-like gallbladder.
4, gallbladder stones larger than 1 cm in diameter and stones embedded in the neck of the gallbladder.
5.Patients with gallbladder stones with recent pain in the epigastric gallbladder area becoming persistent pain and with obvious symptoms of weakness and wasting.
6. Patients with gallbladder adenomyoma and adenoma combined with stones.
7.Gallbladder polyp-like lesions with lesion diameter greater than 10mm, or gallbladder stones combined with polyp-like lesions.
8.Diabetes mellitus combined with gallbladder stones (when diabetes mellitus has been controlled).
9.Children with gallbladder stones.
10.Patients with genetic strain of gallbladder cancer combined with stones.
11.The elderly or those with cardiopulmonary dysfunction combined with stones. The risk of acute attack or complication of gallstones is much greater than that of elective surgery.