【Diagnosis】.
1. Abdominal pain, mostly manifested as right upper abdomen or (and) middle and upper abdomen distension or colic, pain may radiate to the right shoulder and back. It can be accompanied by nausea and vomiting, often after exertion or eating a fatty diet. The attack may be accompanied by fever, and the interictal period is mostly asymptomatic or only shows indigestion symptoms such as postprandial epigastric fullness, eructation, belching, etc.
2. In acute attacks, there are more signs of epigastric pain or limited peritonitis, positive Murphg’s sign, jaundice in about 20%-25% of patients, and generally no positive signs in the interictal period.
3. Ultrasound shows enlarged or atrophied gallbladder, thickened and gross gallbladder wall, and gallbladder stones.
4. During acute attacks, there is an increase in white blood cell count and neutrophils, and a mild increase in bilirubin or transaminases.
【Treatment principle】.
Except for asymptomatic solitary gallbladder stones which can be left untreated, all other cases should be treated actively and early.
1.Non-surgical treatment.
(1) Indications.
(1) First attack, mild inflammation, not severe symptoms, patient unwilling to operate.
(ii) Asymptomatic gallbladder stones.
③As a preparation before surgery.
(2) Methods.
① anti-infection, antispasmodic, biliary.
(2) Diet control, fasting if necessary, gastrointestinal decompression.
(3) Correct the imbalance of water, electrolytes and acid-base balance, and supplement energy and multivitamins.
2.Surgical treatment.
(1) Indications for surgery.
(1) acute cholecystitis for which conservative treatment is ineffective.
(ii) Patients with chronic cholecystitis and gallstones with recurrent episodes of right upper abdominal pain and/or with intractable dyspeptic symptoms.
③ asymptomatic gallbladder stones in which the patient requires surgical treatment.
④ those with inflammation and/or obstruction of the intra- and extra-hepatic bile duct system
(⑤ Acute suppurative, gangrenous or obstructive cholecystitis complicated by biliary peritonitis or already perforated should be operated on urgently.
(2) Preoperative preparation.
(1) Complete relevant examinations, including three major routine tests, liver and kidney function, coagulation function, hepatitis series, syphilis antibody assay, anti-HIV assay, electrocardiogram, chest X-ray, abdominal ultrasound, etc.
(2) For patients with other chronic diseases, such as hypertension and diabetes mellitus, the relevant test indexes should be monitored to control the original disease and improve the tolerance of surgery.
(3) Surgical methods.
① Conventional open cholecystectomy.
(2) Laparoscopic cholecystectomy: If there is no history of upper abdominal surgery, patients who are suitable for simple cholecystectomy can have their gallbladders removed laparoscopically. It has now become the preferred surgical procedure for removal of the gallbladder.
(iii) Cholecystostomy. It is indicated for: extensive adhesions around the gallbladder, heavy inflammation, unclear anatomical relationship; old and frail or critically ill patients who cannot tolerate cholecystectomy; gallbladder perforation wrapped by large omentum to form a surrounding abscess.
④ Cholecystectomy plus common bile duct exploration. It is suitable for patients with biliary obstruction.
【Efficacy criteria
1.Cure: disappearance of symptoms and signs after surgery, no complications and healing of incision.
2.Improved: Symptoms and symptoms basically disappeared after drug treatment.
3.Not cured: untreated patients.