Gallbladder stones are mainly cholesterol stones or a mixture of cholesterol-based stones and black bile pigment stones. They are mainly seen in adults, and their incidence increases with age after 40 years of age, more in women than in men. The causes of gallbladder stones are complex and are related to 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. For example, inhabitants of certain regions and races, female hormones, obesity, pregnancy, high-fat diet, long-term parenteral nutrition, diabetes, hyperlipidemia, after gastrectomy or gastrointestinal anastomosis, terminal ileal disease and ileal resection, liver cirrhosis, and hemolytic anemia. In China, the incidence of gallbladder stones is relatively high in northwest China, which may be related to dietary habits. Clinical manifestations Most patients can be asymptomatic and are only found incidentally during physical examination, surgery and autopsy, called resting gallbladder stones, and with the popularity of health screening, the detection of asymptomatic gallbladder stones has increased significantly. The typical symptom of gallbladder stones is biliary colic, which is present in only a minority of patients, while others often present as acute or chronic cholecystitis. The main clinical manifestations include: 1. Biliary colic typically occurs after a full meal, after eating fatty food or during sleep when the position changes, due to gallbladder contraction or stone displacement plus vagal nerve excitation, the stone is embedded in the abdomen or neck of the gallbladder, gallbladder emptying is obstructed, the pressure in the gallbladder rises, the gallbladder strongly contracts and colic occurs. The pain is located in the right upper abdomen or epigastrium and is paroxysmal, or the pain may increase paroxysmally and may radiate to the right shoulder and foot and back. After the first biliary colic, about 70% of the patients will have another attack within a year. Most patients only feel vague pain in the upper abdomen or right upper abdomen when they eat too much food, fatty food, stressful work or poor rest, or have discomfort of fullness, warmth and rebellion, which are often misdiagnosed as “stomach disease”. 3. Gallbladder effusion gallbladder stones for a long time or obstruction of the gallbladder duct but not combined with infection, the gallbladder mucosa absorbs bile pigments in the bile and secretes mucus substances, resulting in gallbladder effusion. The accumulated fluid is clear and colorless, called white bile. 4. Other ① rarely cause gangrene, even if gangrene is mild; ② small stones can enter and stay in the common bile duct through the cystic duct and become common bile duct stones; ③ stones entering the common bile duct through the oddi sphincter can cause injury or embedded in the jugular abdomen leading to pancreatitis, called biliary pancreatitis; ④ chronic perforation of the gallbladder inflammation caused by stone compression, can cause gallbladder duodenal rash or gallbladder colonic repeatedly, large (4) chronic perforation of the gallbladder due to inflammation of the gallbladder caused by stone compression, which can cause gallbladder duodenal rash or gallbladder colonic rash, and large stones entering the intestine through the ducts can occasionally cause intestinal obstruction called gallstone intestinal obstruction. Mirizzi’s syndrome is a special type of gallbladder stone, formed by anatomical factors such as the long cystic duct with the common hepatic duct or the low confluence of the cystic duct and the common hepatic duct, persistent embedded in the neck of the gallbladder and large cystic duct stones compressing the common hepatic duct, causing narrowing of the common hepatic duct; repeated inflammatory episodes lead to repeated ducts of the gallbladder and the common hepatic duct, the disappearance of the cystic duct and partial or complete blockage of the common hepatic duct by stones. The clinical features are recurrent episodes of cholecystitis and cholangitis with marked obstructive xanthogranuloma. Imaging of the biliary tract reveals a gallbladder or enlarged, dilated common hepatic duct, and normal common bile duct. Diagnosis A clinically typical history of colic is an important basis for diagnosis, and imaging examinations can confirm the diagnosis. Ultrasound is preferred and has an accuracy rate of nearly 100% in the diagnosis of gallbladder stones. Only 10% to 15% of gallbladder stones contain calcium, which can be diagnosed by abdominal X-ray and can be differentiated from right kidney stones by lateral radiographs; CT and MRI can also show gallbladder stones, but are not routinely performed. For treatment of gallbladder stones with symptoms and/or complications, laparoscopic cholecystectomy is the preferred treatment, which is equally effective and less invasive than classical open cholecystectomy. Small incision cholecystectomy is also possible without laparoscopy. Asymptomatic gallbladder stones generally do not require active surgical treatment, but can be observed and followed up. However, surgical treatment should be considered in the following cases: (1) stone diameter (3 Cm); (2) combined with open surgery; (3) accompanied by gallbladder polyps >1 cm; (4) thickened gallbladder wall; (5) calcified gallbladder wall or porcelain gallbladder; (6) gallbladder stones in children; (7) combined with diabetes; (8) with cardiopulmonary dysfunction; (9) remote or underdeveloped transportation areas, field workers; (10) gallbladder stones found in 10 years; (11) gallbladder stones found in the field. ⑩ Gallbladder stones have been found for more than 10 years. In the case of cholecystectomy, common bile duct exploration should be performed in the following cases: ① Preoperative history, clinical manifestations or imaging examination confirm or highly suspect obstruction of the common bile duct, including obstructive xanthogranuloma, common bile duct stones, recurrent biliary colic, cholangitis and pancreatitis. Intraoperative confirmation of common bile duct pathology, such as intraoperative cholangiography confirmed or they have 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, pancreatitis or pancreatic head swelling, bile duct aspiration with purulent, bloody bile or sediment-like bile pigment particles. ③ Gallbladder stones are small and have the potential to enter the common bile duct through the cystic duct. Intraoperative cholangiography or choledochoscopy should be sought to avoid blind biliary exploration and unnecessary complications. T-tube drainage is usually required after common bile duct exploration, and there may be certain complications.