I. Gallbladder function
1.Concentration and storage of juice
2.Contraction and emptying of the gallbladder
3.Secretory function of gallbladder Secretion of mucoglycoprotein and protection of gallbladder mucosa
Current understanding
1.The function of storing bile
2.The function of absorbing and concentrating bile
3.The function of regulating the fluid pressure of the bile duct
The liver makes 800-1000ml of bile every day, which is continuously discharged into the extrahepatic bile duct and maintains a certain pressure, when the regulation of the gallbladder is an important factor. When the extrahepatic bile duct pressure is increased, the gallbladder can hold and concentrate more bile and maintain the pressure balance in the bile duct. When the gallbladder is removed, the role of regulating pressure balance disappears, but the bile secreted by the liver does not decrease, and all the bile must be discharged into the duodenum via the sphincter of Oddis every day. Inevitably, compensatory dilation of bile ducts will occur over time.
4.Maintain the normal physiological function of gastrointestinal tract
A large amount of unconcentrated bile enters the intestine, and because it is thin, the ability to digest fat and protein is weak, and when eating a high-protein, high-fat diet, the digestive ability is weak, which is equivalent to the bile is wasted. If there is a gallbladder, the bile can be concentrated in high concentration, and the gallbladder has a special function to control the excretion of bile skillfully and flexibly with the regularity of human body eating. Therefore, the gallbladder has an important role in regulating the gastrointestinal tract and maintaining the normal physiological function of the gastrointestinal tract.
5.The function of sudden excretion of bile after meals to help digestion
6.Secretory function (secretion of mucin and digestive enzymes)
7.Immune function
The gallbladder mucosa has the function of secreting iga antibodies, which is important for the immune defense of the biliary system, and the concentration of this substance in the bile is much higher than the concentration in the blood, becoming the main source of iga supply to the intestine. If the intestine lacks iga, it can cause defects in the defense function of the small intestine, infectious diarrhea, infectious ascites, and sepsis of gastrointestinal origin; in the colon, overlying the surface of the colon, not stimulated by bile acids, to avoid the risk of colon cancer.
8.Regulate the function of the sphincter of Oddis The dilated bile duct often makes the beak-like end become round and blunt, forming a vortex, into a vortex, which is one of the important doctrines for the formation of bile duct stones – the vortex doctrine.
9.Bile acid enterohepatic circulation function
Second, the main causes of gallbladder stones
1, the main cause of bile cholesterol supersaturation abnormal gallbladder contraction function delayed emptying
Cholesterol oversaturation forms small crystals, then large crystals and stones, and small crystals to large crystals are reversible.
2.Other causes Abnormal human lipid metabolism Genetic susceptibility genes (23 kinds of Lith genes)
3.Other female hormones, obesity, pregnancy, high-fat diet, diabetes, long-term extragastric nutrition, cirrhosis of the liver, hemolytic anemia
In conclusion: any factor that affects the ratio of cholesterol to bile acid concentration and causes stasis can lead to stone formation.
Third, the harm of gallbladder stones
1, biliary colic: typical attacks are related to full meals, eating fatty food or position changes, after one attack, 70% of patients will have another attack within one year.
2, epigastric vague pain: pain is not severe, can be accompanied by fullness, belching, eructation, etc.. It is often mistaken for stomach disease, which repeatedly affects people’s life and work.
3.Gallbladder cancer: Long-term stone and inflammation stimulation can induce it. 70% of gallbladder cancer patients are related to stones. Gallbladder cancer combined with stones is 13.7 times more common than that without stones.
4. Cholangitis and pancreatitis: Small stones enter the common bile duct through the cystic duct causing obstruction and causing cholangitis. It can also cause biliary pancreatitis.
Why do we need biliary stone extraction?
For doctors: 1.
1. A deeper understanding of the limitations of the “hotbed theory” and the increasing importance of the function of the gallbladder. This theory believes that the bile and cholesterol in the gallbladder are oversaturated and crystallized to form stones, which is the famous triangular metabolic theory. However, where does cholesterol come from? It comes from the liver and the bile pigment lobe comes from the liver, neither of which is secreted by the mucosa of the gallbladder, so clinically there are stones wherever there is bile, so there are intrahepatic bile duct stones and common bile duct stones.
2. The rapid development of medical technology and equipment, especially the application of endoscopy, has extended the doctor’s vision to the inside of the gallbladder.
For patients with cholecystectomy.
1, indigestion and bile reflux gastritis
2. Facing bile duct damage due to surgery
It is known that in cholecystectomy surgery, due to the importance of the gallbladder triangle coupled with local tissue adhesions and mutations, bile duct injury brought about by cholecystectomy is inevitable and there is always a certain probability, about 0.18-2.3%, and there is a certain mortality rate, 5-8% in the early stage and 0.17% at present.
3.High incidence of common bile duct stones
4.Increased incidence of colon cancer and pancreatic cancer
There is a literature report of 100 cases of 60 years of age or older with bile cutting and 100 cases without bile cutting, the incidence of colon cancer is 12:3. The reason why gallbladder is prone to colon cancer after cholecystectomy is that secondary bile acids enhance the mitosis of colonic mucosal cells and cause colon cancer.
V. Changes of bile stone extraction
The main stages of biliary stone extraction
1. Open biliary stone extraction, with great trauma and high recurrence. It has been eliminated.
2.Ultrasound-mediated percutaneous cholecystoscopy for biliary stone extraction, with high residual rate. Eliminated.
3, extracorporeal shock wave lithotripsy, easy bile duct blockage. Eliminated.
4.Laparoscopy and choledochoscopy for biliary stone extraction. “True human-centered” , in continuous development
VI. Cholecystectomy indications and contraindications
Indications Gallbladder stones identified by ultrasound or other imaging examinations, good determination of gallbladder function.
Contraindications 1.Gallbladder atrophy and disappearance of gallbladder cavity 2.Gallbladder duct stones which are difficult to be removed by endoscopy 3.Diffuse interstitial stones in gallbladder 4.Gallbladder stones and gallbladder cancer
VII. Bile acid
It has the function of preventing the generation of gallstones. Cholesterol is insoluble in water, so when it is discharged into the gallbladder for storage with bile, the bile is concentrated in the gallbladder and cholesterol is easily precipitated.