Gallbladder stone is a common and frequent disease in hepatobiliary surgery. It accounts for more than 50% of the simultaneous inpatient procedures in our department. They are rare in children, and their incidence increases with age, with 40-50 years being the peak age group for their development. Etiology: The causes of gallbladder stones are complex and not yet fully understood. They are mainly related to lipid metabolism, bile nucleation time, gallbladder contraction function and bacterial infection, which cause changes in the composition and physicochemical properties of bile, resulting in supersaturation of cholesterol in bile and precipitation of stones. Clinical manifestations: The symptoms of gallbladder stones depend on the size and location of the stones, as well as the presence of obstruction and inflammation. About 50% of patients with gallbladder stones are asymptomatic for life, known as occult stones. Larger gallbladder stones may cause symptoms of indigestion such as stuffiness and distension in the upper or right side of the abdomen, belching and aversion to fatty foods. Smaller stones may cause biliary colic and acute cholecystitis when they obstruct the gallbladder duct after a full meal, eating fatty food, or lying down at night. Due to the contraction of the gallbladder, smaller stones may pass through the cystic duct into the common bile duct and cause obstructive jaundice, then some stones may be discharged from the bile duct into the duodenum, and some stones remain in the bile duct as secondary bile duct stones. Stones may also obstruct the bile duct for a long time without infection, and only fluid may form in the gallbladder, at which point an enlarged gallbladder with no obvious pressure can be palpated. In the absence of infection, gallbladder stones usually have no specific signs or only mild pressure pain in the right upper abdomen. However, when there is an acute infection, pressure and muscle tension in the mid-upper and right upper abdomen may be present, and sometimes an enlarged and painful gallbladder may be palpable. Murphy’s sign is often positive. Diagnostic differentiation: Gallbladder stones with a history of acute attacks are generally not difficult to diagnose based on clinical manifestations. Ultrasound examination can correctly diagnose gallbladder stones, showing the light mass in the gallbladder and the acoustic shadow behind it, and the correct diagnosis rate can reach 95%. Oral cholecystography can show the shadow of stones in the gallbladder. In the gallbladder bile obtained during duodenal drainage (i.e. beta bile), bile sand or cholesterol crystals are found, which helps in the diagnosis. Treatment (a) Surgical treatment The chronic irritation of gallbladder mucosa by gallbladder stones can cause inflammation or even cancer of gallbladder, and if the stones are embedded in the neck of gallbladder or gallbladder duct, it can lead to secondary infection. In recent years, there is an increasing trend of gallbladder stones combined with carcinoma. Therefore, the first choice of treatment for gallbladder stones is cholecystectomy. 1.Traditional open cholecystectomy: It has been mastered by most general surgeons, especially used in hospitals where laparoscopy is not carried out at the grassroots level. 2, laparoscopic cholecystectomy: In 1987, Dr. Mouret performed the first case of laparoscopic cholecystectomy (Laparoscopic cholecystectomy, LC) in France, and in the past 10 years, laparoscopic cholecystectomy has rapidly become popular worldwide. It has the advantages of less trauma, less pain, faster recovery, and less local interference with the patient’s whole body and abdominal cavity. It is performed by placing a laparoscope with optical fibers and special surgical instruments in the abdominal cavity through 3-4 small poked holes in the abdominal wall under the monitoring of a TV screen. The indications for the procedure are basically the same as for open cholecystectomy. However, it should be recognized that LC has its limitations, and coupled with the different proficiency of operators, it cannot completely replace open cholecystectomy. 3. Cholecystostomy: For critically ill cases, patients with severe cardiac, hepatic, renal and whistling insufficiency, or patients who cannot tolerate cholecystectomy due to the technical level of primary hospitals, cholecystostomy for stone extraction is feasible, and cholecystectomy will be performed in the second stage. (B) Lithotripsy The main mechanism of gallbladder stone formation is the change of bile physicochemical composition, the narrowing of bile acid pool and the increase of cholesterol concentration. In 1972, Danjinger firstly applied goose deoxycholic acid and succeeded in dissolving cholesterol stones in 4 cases. However, this drug has certain toxic reactions on the liver, such as elevated glutamate transaminase, and can irritate the colon and cause diarrhea. At present, the main drugs for lithotripsy are goose deoxycholic acid and its derivative ursodeoxycholic acid. Indications for treatment: ① gallbladder stones less than 2 cm in diameter; ② gallbladder stones with little calcium that can be transmitted by X-ray; ③ gallbladder duct patency, i.e. a functional gallbladder can be shown on oral cholecystography; ④ the patient’s liver function is normal; ⑤ there is no obvious history of chronic diarrhea. The therapeutic dose is 15 mg/g per day for 6 to 24 months. The efficiency of stone dissolution is generally 30-70%. Ultrasound or oral cholecystography was performed once every six months during the treatment period to understand the dissolution of stones. Since the value of such lithotripsy drugs is expensive, and there are certain side effects and toxic reactions, and must be taken for life, if 3 months after stopping the drug, the cholesterol in the bile will become supersaturated again, the stones will recur, according to statistics, the recurrence rate of 3 years can reach 25%, there are still some limitations of such lithotripsy treatment. In addition, some new drugs, such as Rowachol and metronidazole, also have some lithotripsy effect. In 1985, it was reported that percutaneous hepatic puncture was used to inject glycerol monolipid caprylate or methyl tert-butyl ether into the gallbladder, and lithotripsy was achieved directly in the gallbladder. (iii) Extracorporeal shock wave lithotripsy In 1984, Lauerbwch first used extracorporeal shock wave-lithotripsy (ESWL) for the treatment of cholelithiasis. The commonly used shock wave lithotripsy machine is EDAP LT-01, which consists of 320 piezoelectric crystals embedded in a paraboloidal disc, synchronously emitting shock waves to form a 4 mm wide and 75 mm long aggregation area with an acoustic pressure of 9×107 PZ. The stones can be crushed. In addition, B-mode ultrasound is also used for real-time imaging to locate stones and monitor the process of lithotripsy. The main indications for the treatment of gallbladder stones by shock wave lithotripsy are cholesterol stones in the gallbladder, negative stones on oral cholecystography, no more than 3 stones with a diameter of 12-15 mm and only 1 stone with a diameter of 15-20 mm, and the requirement of a normal gallbladder contraction. To improve the disappearance rate after stone crushing, ursodeoxycholic acid (UDCA) 8 mg/kg/d was administered before and after shock wave to achieve synergistic effect of stone crushing and lithotripsy. To consolidate the efficacy of the treatment after the disappearance of stones, it can be continued for six months. This method still has about 11.2% stone recurrence rate, expensive treatment and strict therapeutic indications, which are all shortcomings. In summary, surgical cholecystectomy is the first choice for patients suffering from gallbladder stones, and laparoscopic cholecystectomy is the first choice for surgical treatment. The timing of the operation is preferable to the interval of acute attack. Since laparoscopic cholecystectomy was carried out in the mid-1990s, our hepatobiliary surgery department has done a large number of cases and helped many county and municipal hospitals in the surrounding areas to carry out laparoscopic cholecystectomy, which has accumulated rich clinical experience. Other methods of lithotripsy and lithotripsy for stone removal are used with caution, as gallbladder stones can lead to serious complications once they are discharged into the bile duct.