Gallbladder stones are mainly seen in adults, more in women than men, and their incidence increases with age after the age of 40. The stones are cholesterol stones or a mixture of cholesterol-based stones and black bile pigment stones. Etiology Gallbladder stones are associated with a variety of factors. Any factor that affects the ratio of cholesterol to bile acid concentration and causes bile stagnation can lead to stone formation. Individual regional and ethnic residents, female hormones, obesity, pregnancy, high-fat diet, long-term parenteral nutrition, diabetes mellitus, hyperlipidemia, after gastrectomy or gastrointestinal anastomosis, terminal ileal disease and ileal resection, cirrhosis of the liver, and hemolytic anemia can all cause gallbladder stones. The relatively high incidence of gallbladder stones in the northwest of China may be related to dietary habits. Clinical manifestations Most patients are asymptomatic and are found only during physical examination, surgery and autopsy, which is called stationary gallbladder stones. The typical symptom of gallbladder stones in a small number of patients is biliary colic, which manifests as acute or chronic cholecystitis. The main clinical manifestations are as follows: 1. Biliary colic Patients often have colic due to contraction of the gallbladder or stone displacement after a full meal, eating fatty food or during sleep when the position changes. The pain is located in the right upper abdomen or epigastrium and is paroxysmal, or the pain may increase in paroxysms, radiating to the right scapula and back, and may be accompanied by nausea and vomiting. Some patients are unable to name the exact site of pain because of the severity of the pain. After the first appearance of biliary colic, about 70% of patients will recur within a year. 2, epigastric vague pain Most patients only feel vague pain in the upper abdomen or right upper abdomen when they eat too much food, eat high-fat food, work under stress or have poor rest, or have fullness, belching, erratic, etc., which can be easily misdiagnosed as “stomach disease”. Gallbladder effusion When gallbladder stones are embedded for a long time or obstruct the gallbladder duct but not combined with infection, the gallbladder mucosa absorbs bile pigments in the bile. Mucus material is secreted, forming gallbladder effusion. The fluid is transparent and colorless, also known as white bile. (2) Small stones can enter the common bile duct through the cystic duct and become common bile duct stones; (3) Stones in the common bile duct are embedded in the jugular abdomen through the sphincter of Oddi, leading to pancreatitis, called biliary pancreatitis; (4) Inflammation of the gallbladder caused by stone compression and chronic perforation can result in cholecystoduodenal fistula or cholecystocolic fistula, and large stones enter the intestinal tract through the fistula (5) Stones and long-term inflammatory stimulation can induce gallbladder cancer. Mirizzi’s syndrome is a special type of gallbladder stone, which is caused by the low confluence of the cystic duct and the common hepatic duct, and the persistent obstruction of the common hepatic duct by large stones embedded in the neck of the gallbladder. The recurrent inflammatory episodes lead to fistula of the common hepatic duct, loss of the cystic duct and partial or complete blockage of the common duct by stones. The clinical presentation is recurrent cholecystitis and cholangitis with marked obstructive jaundice. Imaging of the biliary tract reveals an enlarged gallbladder, dilated common hepatic duct, and normal common bile duct. Diagnosis Based on the typical clinical history of colic, imaging examinations can confirm the diagnosis. Ultrasound examination is preferred, and the diagnosis of gallbladder stones is confirmed by the presence of a strong echogenic mass in the gallbladder, which moves with position change and is followed by an acoustic shadow. Only 10%-15% of gallbladder stones contain calcium, and the diagnosis can be confirmed by abdominal X-ray. However, it is not used as routine examination. Treatment 1.Laparoscopic cholecystectomy is the first choice. It is less invasive and more effective than the traditional open cholecystectomy. Asymptomatic gallbladder stones generally do not require active surgical treatment, and can be observed and followed up, but the following cases should be considered for surgical treatment: (1) stones ≥ 3 cm in diameter; (2) combined with the need for open surgery; (3) with gallbladder polyps > 1 cm; (4) gallbladder wall thickening; (5) gallbladder wall calcification or porcelain gallbladder; (6) children with gallbladder stones; (7) combined with diabetes; (8) with cardiopulmonary (9) remote or underdeveloped transportation areas, field workers; (10) gallbladder stones found more than 10 years. (1) Preoperative history, clinical manifestations or imaging examination confirm or highly suspect obstruction of the common bile duct, including obstructive jaundice, common bile duct stones, recurrent biliary colic, cholangitis and pancreatitis. (2) Intraoperative confirmation of lesions in the common bile duct, such as intraoperative cholangiography confirming or palpating stones, roundworms, masses in the common bile duct, dilatation of the common bile duct more than 1 cm in diameter, significant thickening of the bile duct wall, finding pancreatitis or pancreatic head mass. Bile duct puncture was performed to extract purulent, bloody bile or sediment-like bile pigment particles. (3) Gallbladder stones are small and may enter the common bile duct through the cystic duct. To avoid blind biliary exploration and unnecessary complications, intraoperative cholangiography or choledochoscopy is feasible. T-tube drainage is usually required after common bile duct exploration, which has certain complications.