Gallbladder stones and cholecystitis are not unfamiliar to people and are common diseases among the public. With the improvement of living standard and the increase of cholesterol food intake, their incidence is as high as 7-10%. With the advancement of medical technology, gallbladder stones and cholecystitis can be diagnosed at all levels of medical institutions, including community health centers, and different types of treatment plans can be provided. Based on my clinical experience over the years, the author summarizes the misconceptions about the diagnosis and treatment of gallbladder stones and cholecystitis as follows.
1, gallbladder stones, cholecystitis misdiagnosed as gastric disease.
The gallbladder is closely adjacent to the stomach and duodenum, and the innervation and blood supply of the gallbladder are from the same trunk as the nerves and blood vessels of the stomach and duodenum. Therefore, the pain sensation caused by gallbladder lesion is transmitted to human brain through the same sensory nerve trunk of stomach and duodenum, coupled with the imprecise positioning of abdominal visceral nerves, it is difficult to distinguish the upper abdominal pain caused by gallbladder stones from stomach and duodenal diseases, and the commonly used acid-suppressing and pain-relieving drugs have certain curative effects on gallbladder, stomach and duodenal diseases, so many patients have been treating their gallbladder diseases as gastric diseases. .
2, missed diagnosis of other serious diseases, gallbladder stones become the “scapegoat”.
The right upper abdominal pain symptoms of gallbladder stones and cholecystitis are very similar to the abdominal pain caused by liver cancer and colon and liver flexure cancer, so clinically many doctors ask for a simple medical history and are easily satisfied with the diagnosis of gallbladder stones, relying on ultrasound examination to find gallbladder stones and then perform cholecystectomy, only to find out that it is liver cancer or colon cancer during or after surgery, which delays the early treatment. Therefore, the diagnosis of gallbladder stones should be carefully distinguished from the above two types of tumors so that gallbladder stones do not become the “scapegoat”. In addition, the acute pain of gallbladder stones should be differentiated from acute myocardial infarction and right-sided pleurisy.
3, “stationary” gallbladder stones “preventive” surgery.
Many people have one or more stones in the gallbladder found by ultrasound during physical examination, but in daily life there is no pain in the right upper abdomen or upper abdomen, no gastrointestinal symptoms, such gallbladder stones are medically known as “stationary” stones. The so-called “resting” gallbladder stones are harmless and do not need to be removed surgically, and there is no theoretical basis for the so-called prophylactic removal. Only when gallbladder stones are complicated by biliary colic, cholecystitis or jaundice caused by stones are they harmful to people, and only then do they need to be treated.
4, recurrent gallbladder stones and cholecystitis refuse to operate.
When gallbladder stones are complicated by cholecystitis, the gallbladder loses its normal physiological function of storing and concentrating bile due to inflammation and has an abnormal pathological effect.
First, repeated inflammation, repeated epigastric pain, so that people can not work and live normally;
Secondly, once the gallbladder is inflamed, medical treatment such as antibiotics alone can only relieve the symptoms and temporarily reduce inflammation, but the changes in the gallbladder tissue caused by inflammation make recurrent inflammation of the gallbladder almost inevitable.
Therefore, we can always see many such patients in the clinic, that is, a gallbladder inflammation by conservative medical treatment to relieve frequent attacks, and the attack duration is getting longer and longer, the interval is getting shorter and shorter, and the symptoms are getting heavier and heavier.
Thirdly, repeated inflammation of the gallbladder can cause gallbladder necrosis and gallbladder perforation in severe cases. Once necrosis or perforation occurs, it can cause the medical condition called “acute peritonitis”, which is much more dangerous than simple cholecystitis, and even life-threatening.
Fourth, when the gallbladder is inflamed, the violent contraction of gallbladder stones into the bile ducts causes bile duct obstruction, and then the bile that cannot be discharged to the intestine enters the bloodstream in large quantities, causing the symptoms called “obstructive jaundice” in medicine, which can also cause acute cholangitis, acute pancreatitis, and even life-threatening in serious cases.
Fifthly, gallbladder stones and cholecystitis may also become cancerous if they occur repeatedly. Therefore, as long as the gallbladder stones are complicated by acute cholecystitis or chronic cholecystitis, in principle, the most reasonable and thorough treatment is to remove the diseased gallbladder as soon as possible.
5. Abuse of lithotripsy and lithotripsy drugs.
Lithotripsy has a long history, and the early application of goose deoxycholic acid lithotripsy in the 1970s was successful. But oral lithotripsy is not easy to reach the gallbladder to act on the stones, and direct injection of drugs into the gallbladder lithotripsy also has a certain degree of risk, and because of the long course, low cure rate, high recurrence rate, and many side effects, lithotripsy treatment has been abandoned by professional treatment of gallbladder stones medical institutions at home and abroad.
Because of the long and slender gallbladder duct and spiral flap, most of the patients cannot expel the gallbladder stones after taking oral lithotripsy drugs, which may even cause serious consequences such as stone impaction in the neck of gallbladder, biliary ductitis and pancreatitis. At present, many bile acid drugs and proprietary Chinese medicines are not lithotriptic, but they still claim to treat gallstones and are widely sold, but in fact, they are often ineffective.
6. Believe in the “new” bile stone extraction procedure.
For the treatment of gallbladder stones, gallbladder lithotripsy is a procedure that has been eliminated and is not a radical surgery. The reason why stones grow in the gallbladder is that there are pathological factors in the gallbladder itself, even if the stones are ideally removed, the diseased gallbladder is not removed and the stones will continue to grow. Even if the stones are ideally removed, the diseased gallbladder is not removed and the stones will continue to grow. Clinically, cholecystostomy can be used as decompression and drainage for high-risk people who are not suitable for cholecystectomy for the time being, and after the condition is stabilized, it is still advocated to perform cholecystectomy again.
7. Blind lithotripsy treatment.
External liquid wave lithotripsy may break the gallbladder stones, but because of the special structure of the gallbladder duct, it is difficult to completely discharge the broken stones from the gallbladder, and even if they are discharged to the bile duct, it is difficult to discharge them smoothly through the lower end of the narrow bile duct, which will instead block the common bile duct and cause serious consequences such as cholangitis and pancreatitis. This is different from the treatment of urinary stones by lithotripsy, because the urinary tract can secrete a large amount of urine, which can flush the crushed stones out of the body. Therefore, this treatment modality is now obsolete.