Etiology: Changes in the composition and physicochemical properties of bile lead to supersaturation of cholesterol in the bile. In addition, the presence of nucleating factors, the reduced contractility of the gallbladder, and the stagnation of bile can promote the formation of stones.
Symptoms: vague pain in the right upper abdomen and subxiphoid process, especially after greasy food, gastrointestinal symptoms such as indigestion (e.g. right upper abdomen or epigastric fullness, loose stools). Some patients can be asymptomatic. Hou Dongsheng, Minimally Invasive General Surgery Department, The First Hospital of Guangzhou Medical University
Examination:Pressure pain in the gallbladder area in the right upper abdomen on physical examination; some patients can have no pressure pain. Auxiliary examination: mainly abdominal ultrasound, the correct diagnosis rate is over 95%.
Treatment: mainly divided into non-surgical treatment and surgical treatment.
1.Non-surgical treatment.
(1) For asymptomatic gallbladder stones, it is generally believed that immediate surgical treatment is not needed, only regular abdominal ultrasound observation and follow-up, and pay attention to diet, avoid greasy and high-fat diet.
(2) Patients with mild symptoms or those who are reluctant or unsuitable for surgery can be treated with anti-inflammatory and biliary drugs to improve bile metabolism and liver protection, and pay attention to diet to temporarily relieve symptoms, and then undergo minimally invasive surgery when conditions are available.
2.Surgical treatment: Cholecystectomy is the preferred method to cure gallbladder stones.
Surgical treatment should be considered promptly in the following cases.
1.Patients with symptoms and recurrent attacks;
2, oral cholecystography does not show or the gallbladder contraction function test shows poor function
3, with or without symptomatic gallbladder stones, stone diameter more than 2-3cm, and thick gallbladder wall (>3-4mm)
4, combined with diabetes mellitus, at the time of diabetes control
5, elderly people, older and/or with cardiopulmonary dysfunction. Patients with the latter two conditions are at far greater risk of being forced to perform emergency surgery in the event of an acute attack or complications than elective surgery.
There are several surgical methods as follows.
1, cholecystectomy is the preferred method to cure gallbladder stones. At present, laparoscopic cholecystectomy, especially micro (needle type) and single-hole laparoscopic cholecystectomy is performed in our hospital, which is less traumatic than ordinary laparoscopic surgery and takes exactly the same operating time, and is considered to be the most ideal surgical way to treat gallbladder stones. Patients have less trauma, faster recovery, less pain and shorter hospital stay, and it is generally accepted as a mature procedure by medical staff and patients. Our hospital has accumulated more than 16,000 cases of laparoscopic cholecystectomy experience from the first laparoscopic cholecystectomy in China in 1991, mini-laparoscopic cholecystectomy in 1997, to single-hole laparoscopic surgery now.
The indications for minimally invasive surgery with gallbladder preservation are: gallbladder stones, relatively mild or asymptomatic symptoms, good contractile function of gallbladder, no obvious inflammation of gallbladder, no obvious thickening of gallbladder wall, no obvious abnormality of gallbladder structure, young patient (under 55 years old), b definite request for gallbladder preservation, and full understanding of postoperative disease development, laparoscopy, choledochoscopy and nephroscopy. In these cases, the gallbladder can be removed under laparoscopy, using the choledochoscopic and nephroscopic techniques. However, the cause of the stone still exists and there is a possibility of stone recurrence in the future, which requires another surgery; this surgical treatment method is still inconclusive, and there is still no report of a large number of clinical cases with efficacy more than 5 years after surgery. The minimally invasive surgery center of our hospital has accumulated a lot of clinical experience in bile preservation surgery in these years.
3.Subabdominal cholecystectomy is a surgical procedure for patients with serious inflammation, congestion and edema of gallbladder, unclear delineation of gallbladder triangle, and difficulty in dissecting gallbladder triangle for better prevention of biliary tract injury and other tissue damage.
4.Traditional open surgery can be used for some units limited by medical conditions or for patients with poor economic conditions or for those who have not ruled out malignant lesions or whose patient conditions do not allow minimally invasive surgery. The procedure of laparoscopic surgery in Aman planted boy skeleton dazzling hill to talk about the gallbladder sanders marshy ∪ hissing roach fierce quality entertainment
5, the gallbladder lithotomy, the patient combined with lethargic edge has been assiduous В anchor unloading bureau (19) blemishes and the pancreas 砬榭 soft-shelled, old, can not tolerate surgery, in order to save the patient’s life, first simple lithotomy, and then after the condition is stabilized with laparoscopic or open removal of the gallbladder.
Other treatment methods: extracorporeal lithotripsy, lithotripsy effect is very poor, not desirable!