According to statistics, the incidence of gallstone disease in China has reached 10%, 80% of which are gallbladder stones, while asymptomatic gallbladder stones account for 31.7% to 71.4%. In recent years, the trend of gallbladder removal surgery has been increasing year by year. The main reasons for this are.
1, due to the change in the dietary structure of our diet, the intake of meat food has increased significantly, and the consumption of fried, refined noodles and refined rice in the form of fast food has increased significantly, thus causing a significant increase in the incidence of cholelithiasis.
2. the widespread use of advanced examination instruments such as “ultrasound”, which makes gallbladder disease easily detectable.
3, many people think that the gallbladder is a dispensable organ, leaving a diseased gallbladder instead is easy to invite cancer.
4, at present, due to the popularization of laparoscopic cholecystectomy, cholecystectomy has become a minor surgery from the original open surgery to a “breeze”. Is the gallbladder really dispensable? Should the gallbladder be “laid off” if it is afflicted?
A, the gallbladder is not “useless”
The gallbladder is an important organ of the digestive system. The gallbladder converges with the hepatic duct from the liver through the long and slender cystic duct, and then forms the common bile duct down into the duodenum. The relationship between the gallbladder and the common bile duct is like the relationship between the reservoir and the river. At the far downstream of the “river”, there is a “gate” called the common bile duct sphincter. Normally this gate is closed. The bile produced by the liver flows downstream, is blocked at the gate, and then returns to the gallbladder for storage. Do not look at the “reservoir” of the gallbladder “water storage” only a small 50 ml, but has a strong concentration function that the general reservoir does not have: constantly absorb the water in the bile, so that the bile concentrated 5 to 10 times, so that it forms a very bitter taste, dark brown-yellow viscous liquid. liquid. When people eat, food entering the stomach and duodenum can reflexively cause the sphincter of the common bile duct to open, while the gallbladder contracts, discharging a high concentration of bile into the small intestine to help digestion of food, especially the digestion and absorption of fatty foods. At the same time, many fat-soluble vitamins, such as vitamins A, D, E and K, as well as calcium and iron, are digested and absorbed with the participation of bile. After the gallbladder is removed, some of its functions can be compensated by the dilated common bile duct, which generally will not have significant effects on the organism in a few years or a decade, but if the time is too long, some patients with incomplete gallbladder function may have malabsorption of the above vitamins and calcium and iron, leading to iron deficiency anemia and osteoporosis. Therefore, the gallbladder is not an insignificant “useless” for our organism.
Second, which diseased gallbladder should be “sick on duty” or “suspended”
1, gallbladder polyps to stay to see the effect
Since the popularity of “B ultrasound” technology in the 80s, the diagnosis of gallbladder polyps frequently, many patients and even some doctors are “polyp cancer theory” one-sided misleading, often indiscriminate, see polyps on the “kill The practice of “killing a polyp” is really “I would rather kill a thousand by mistake than miss one”. In fact, the “polyps” diagnosed by ultrasound examination can be questioned, at least 90% of them belong to the “cholesterol crystals” that are not cancerous, and under ultrasound, the “bright spots” with a diameter of 3-5 mm are shown. “They are not cells per se, so they are not cancerous. They are not cells in themselves, and naturally will not become cancerous, but due to the gallbladder in the process of concentrating bile “buried hard work” and “accumulated work”, the so-called “no credit but also hard work “. In addition, we should also consider that it still has a concentrated function, which can serve us for a few more years.
Among the gallbladder polyps, 10% of them are adenomatous and inflammatory polyps, which are composed of proliferating glandular cells, and they do have the possibility of cancer, usually appearing as a single polyp, larger in size and larger than 10 mm in diameter, which may clinically cause abdominal pain and other symptoms, and such polyps should be treated as early as possible. Therefore, the four words “single”, “large”, “long” and “painful” are often used to judge gallbladder polyps as indications for gallbladder removal. “Single” refers to a single isolated polyp; “large” means that the maximum diameter of the polyp is 10 mm or more; “long” means that the polyp is found to grow faster in a short period of time during dynamic observation. “Pain” means that the patient has symptoms such as right upper abdominal pain and dyspepsia. In line with these four words, gallbladder polyps should be cholecystectomy as soon as possible to eliminate the consequences.
2.Gallbladder stones should be treated differently
Among gallbladder diseases, the most common is still gallbladder stones. Should gallbladder stones be surgically removed from the gallbladder? When to operate? These are not only the concerns of patients, but also the long-standing controversial issues among experts.
Gallbladder stones have the following characteristics.
(1) Among those who suffer from gallbladder stones, about 60% are asymptomatic for 10 years, about 50% are asymptomatic for 20 years, and about 40% are asymptomatic for life.
(2) The cancer rate of gallbladder stones is not high, about 2% to 5%, and most of them occur after the age of 50.
(3) Various lithotropic drugs advertised in the market are basically ineffective, especially for gallbladder stones larger than 10 mm in diameter, which “cannot be dissolved” and “cannot be dissolved”. Moreover, in vitro tests have proved that some drugs with litholytic effect are often quite toxic, so we should not rely too much on drugs to dissolve stones.
(4) The larger the gallbladder stone, the greater the harm is not necessarily. On the contrary, some small stones like rice or pea size can easily fall into the common bile duct and get stuck at the lower gate, causing life-threatening cholangitis or pancreatitis, which is much more harmful than large stones.
Therefore, we should take the following attitude towards gallbladder stones: for young patients who are first found to have gallbladder stones, they should be advised not to be nervous, and as long as there are no symptoms, they can consider observing the gallbladder for a few years and try to let it serve for a few more years. Of course, once symptoms such as biliary colic occur, removal should be considered. During the period when the gallbladder is “working with disease”, do not overeat and reduce grease in your diet; patients over 50 years of age can choose the appropriate time to have their gallbladder removed; patients over 80 years of age, or patients with other serious diseases who are in poor health and should not undergo cholecystectomy, should be considered as long as gallbladder stones do not cause symptoms. “peaceful coexistence”. Only the usual attention should be paid in the diet to prevent acute attacks of cholecystitis.
3, intrahepatic bile duct stones are not the gallbladder’s “fault”
Intrahepatic bile duct sediment-like stones, is a type of disease unique to China and Southeast Asia. These stones are mostly formed by bile pigment crystals, and their pathogenesis is completely different from that of gallbladder stones. One of its most characteristic features is that the lesion is intrahepatic and rarely involves the gallbladder. For many years, doctors have been making a “mistake” in dealing with this type of disease: while removing intrahepatic bile duct stones, they “incidentally” remove the gallbladder as well. In fact, this practice is ineffective in preventing the recurrence of intrahepatic stones, and is tantamount to “being punished for no fault, and being linked to nine families”.
How to prevent the gallbladder from being “laid off” in advance
In order not to let the gallbladder laid off in advance, we must do a good job of prevention of gallbladder disease from the following aspects: 1.
1, reasonable diet: prevention of gallstones, diet is very important. Overall cholesterol intake should be limited, should not eat animal offal, seafood, less fried food and pastry, less refined rice and noodles, stimulating spices, carbonated drinks, alcohol and other foods that promote the secretion of gastric juice, gastric juice will stimulate the gallbladder contraction, increasing the occurrence of stones. Diet should pay attention to the meat and vegetables, eat a little more plant fiber, refined meat and fish food, river fish. In addition to achieve a regular diet, the combination of work and rest is also very critical.
2, scientific weight loss: research has confirmed that long-term excessive dieting can lead to malnutrition and induce gallstone disease. As we all know, the main function of bile is to digest food, food to eat more, bile secretion is large; on the contrary, food to eat less, bile secretion is less, the rate of bile acid synthesis decreases. In addition, the decrease of glucuronolactone content in bile can prompt the activity of β-glucuronolactonease to increase, which will hydrolyze conjugated bilirubin into unconjugated bilirubin, causing changes in bile composition and thus promoting cholelithiasis. Therefore, long-term excessive dieting, especially often do not eat breakfast or irregular diet is a risk factor for the occurrence of cholelithiasis, should be corrected.
3, moderate exercise: now people live well, exercise less, go out to play, go upstairs to take the elevator, as a result of people’s stomach, body fat, hands and feet stupid. Studies have confirmed that obese people’s bile is cholesterol high saturation state, can contribute to the formation of stones. When weight loss occurs after moderate exercise, bile is unsaturated with cholesterol and is less likely to form cholesterol stones. Therefore, moderate exercise is of some significance to prevent gallbladder stones.
In short, it is still a “fashion” to remove the gallbladder. However, we would like to remind you not to remove the gallbladder in a uniform manner. When the situation allows, it is necessary to “spare the knife” to see what happens later. If the gallbladder is heavily diseased, has lost its proper function, or even acute inflammation or cancer, and become a source of harm, from the overall interests of the human body, should not hesitate to let it “lay off”.