1, in the pathogenesis of the past understanding is only limited to the physiological, biochemical and pathophysiological level, has been in a higher source to find the cause, that is, at the genetic level to understand the evolutionary process of human interaction with nature and the evolution of lifestyle in the causes of stones in the essential changes, in the hope that the prevention of stones to find a fundamental solution. Although we have identified a number of gene loci that are clearly associated with stone formation through genealogical analysis, little is known about how these loci stimulate a series of chain reactions thereafter. Therefore, the research in this area can only be said to be in the initial stage. 2, in the epidemiological aspects of the new findings of the epidemiological characteristics of gallbladder stones: (1) more women; (2) more than 40 years of age; (3) more obese; (4) more breakfast fasting; (5) more people with a family history. The investigation of more than 30,000 cases of gallbladder stones found some new features: (1) the age of onset to 40 years of age, and there is no gender difference; (2) rapid weight loss after the increase in the incidence of stones; (3) taking contraceptives gallbladder stone incidence increased; (4) fatty liver or a history of hepatitis stone incidence increased; (5) sitting for a long time at work or lack of exercise in the incidence of gallbladder stones also increased; (6 ) The proportion of combined common bile duct stones increases significantly with age These findings provide the basis for the ideas that I have proposed in recent years and that have been widely accepted in the field. Progress in diagnosis Ultrasound is the best way to diagnose gallbladder stones or polyps, but for choledochal stones, it is better to do magnetic resonance to show the whole length of the bile duct. If cancerous gallbladder polyps or gallbladder cancer is suspected then it is better to do an enhanced CT.Nowadays, routine MRI is advocated for the elderly as it has been found that the combination of choledochal stones is 30% in those with gallbladder stones at the age of 60 years and increases to 60% at the age of 90 years. In view of the national situation, we recommend magnetic resonance in the following cases: (1) those with multiple stones of long duration; (2) those of advanced age; (3) those with a history of jaundice or frequent back pain; (4) those with a history of pancreatitis, especially those with recurrent episodes; (5) frequent episodes of biliary colic or with fever and jaundice; and (6) those with ultrasound suggestive of dilatation of the common bile duct. In fact, the existing imaging tests have their own characteristics, not the highest price is the best, so both the physician, and the patient should be clear about the purpose of the examination under the circumstances of the choice of means of examination. In this regard, the physician has the main responsibility! 4, progress in the treatment of gallbladder stones, the treatment of no more than three options. One is to wait and see; the second is to remove the gallbladder; the third is to preserve the gallbladder and remove the stone. For asymptomatic stones, the vast majority now advocate no treatment. The theory is that many patients are asymptomatic for life. In fact, this theory has no objective basis. I have been trying to find a convincing basis for this, but so far I have not been able to do so. On the contrary, nearly 20 years of observation and investigation found that the so-called gallbladder stones, “the concept of symptoms” is a long-term “only know what it is, do not know why” misunderstanding. In the past, when a patient presented with typical biliary colic, he or she was considered to have gallbladder stone symptoms, and non-specific symptoms such as vague pain in the upper abdomen, abdominal distension, and dyspepsia were regarded as gastrointestinal symptoms. This is the understanding before the emergence of B ultrasound, because at that time we do not have a way to timely and simple detection of gallbladder stones, often waiting for the emergence of typical symptoms to be diagnosed, such as high fever, the right epigastrium to see the enlarged gallbladder, and “suction stopping sign” (i.e., the patient deep inhalation due to the position of the gallbladder downward, the physician’s finger tip of the top of the gallbladder, then there is obvious pain, the patient instinctively sudden The patient instinctively and suddenly stops breathing). Nowadays, more than 70% of the patients with gallbladder stones are found because of “digestive” problems or because of routine physical examination, in fact, the so-called “digestive symptoms” at this time are the atypical symptoms of cholecystitis. Therefore, the outdated idea of defining gallbladder stone symptoms by whether or not there are typical biliary colic symptoms needs to be re-examined, or else it will bring obstacles to the development of future gallstone disease treatment modes. The second is to remove the gallbladder, as long as the gallbladder stones cause biliary colic, then “everything”. This is the unchallenged code of surgical gallbladder stone treatment that has ruled the surgical world for more than 100 years. The rationale is that stones come from the gallbladder, the gallbladder is the hotbed of stones, and removal of the gallbladder will eliminate the problem forever. There is nothing wrong with the result; with the gallbladder gone, gallbladder stones naturally cease to exist. However, for living organisms, especially the human body, the gallbladder cannot simply be regarded as a dispensable component, which has been challenged by basic theoretical research in medicine and advances in modern surgical treatment techniques. The development of gallbladder stones is a process that goes through a genetic phase, a physiological and biochemical phase, a physical phase, a clinical symptomatic phase and a complication phase. The danger of gallbladder stones lies not only in the effects on the gallbladder itself, such as decreased gallbladder contraction and concentration and obstruction of the cystic duct, but more importantly in the complications caused by gallbladder stones, such as acute pancreatitis and choledocholithiasis, which are much greater than the effects of the gallbladder itself. Since stones are the cause of these problems, preventing their production or eliminating them is naturally the key to solving the problem. The emergence of lithotripsy, lithotripsy and stone removal in the mid-1980s was hot for a while, but ended 10 years later with inaccurate results and obvious side effects. In the meantime, small incision biliary lithotripsy once appeared, but it was left out because of the high recurrence rate. The arrival of the minimally invasive surgery era, for the blind bile cutting school, more firmly “to cut the” belief, but for the other camp of rational bile preservation school, has found a popular solution to the humanization of the majority of patients, and this humanization is based on personalized basis. Imagine a well-functioning gallbladder, with a very small, even imperceptible trauma, removed the stones, so that the gallbladder continues to work for you for a long time, or even 3-5 years, you say does not make sense? One of my online surveys found that almost 100% of patients are willing to preserve the gallbladder first, and then cut the gallbladder if the stone recurs, which is also worthwhile for a well-functioning gallbladder. The so-called rational bile preservation should have: (1) after explaining the pros and cons of bile preservation, the patient has a request for bile preservation; (2) by the impact of the examination of the gallbladder is clearly functional; (3) after analyzing the stones out of the recurrence of stones is not easy to find a preventive link (eg, a single stone, or a large stone but similar size; there are obvious stone susceptibility factors, such as the morning does not eat the habit of eating, nighttime food, long-term sitting work, rapid weight loss, long-term use of birth control pills, etc.). Long-term use of birth control pills, etc.); (4) The treatment method is mild to the body. The most commonly used methods are: small incision stone removal; laparoscopic stone removal. Although the small incision technique was once cold-shouldered, but due to the improvement of the technology there is a resurgence of the scene, now Beijing and Guangzhou to take most of the adoption of this technology. Its technical requirements are relatively low, as long as there is a choledochoscope on the line, can be popularized in primary hospitals. Laparoscopic lithotripsy has relatively high technical requirements, which not only requires the hospital to carry out very good equipment, but also the physician has a wealth of experience in minimally invasive surgery, especially with choledochoscopic lithotripsy and minimally invasive suturing skills. At present, this technology has begun to radiate from Shanghai to the surrounding area.