Gallbladder stones
I. Anatomy of the biliary tract
1.The size and volume of gallbladder
8-300px×3-125px, 40-60ml
2.The thickness of gallbladder wall
Generally less than 3mm, ≥4mm is defined as gallbladder wall thickening
3.Bile duct diameter
Intrahepatic bile duct: 0,30-8,75px, more than 12,5px is regarded as pathological state
Common bile duct: 0, 6-20px, more than 25px is considered as pathological state
4.Gallbladder triangle
There are gallbladder artery, right hepatic artery, gallbladder lymph node and parametrical right hepatic duct passing through.
Biliary tract physiology
1.The amount of bile secreted by adults daily
800-1200ml, which can be concentrated 5-10 times by the gallbladder (PTCD)
2.Daily gallbladder secretion
20ml of mucus, that is, white bile (PTBD)
3.Normal value of blood bilirubin
TBil5, 13-22, 24umol/L (0, 3mg/dl-1, 3mg/dl)
DBil1, 70-8, 55umol/L (0, 1mg/dl-0, 5mg/dl)
4.Normal value of plasma amylase ≤125U/L
III. Clinical manifestations
1.Factors determining clinical manifestations
Location, whether it causes obstruction, whether it is infected
2. manifestations of obstruction (jaundice, bile duct dilatation, liver distension and pain)
3, manifestations of infection (high fever and chills, shock, neurological symptoms)
4.Performance of vagal excitation
Discomfort and fullness, nausea and vomiting, biliary colic
IV. Major complications of cholelithiasis
1.Acute cholecystitis.
2.Acute cholangitis.
3.Biliary pancreatitis
4.Mirizzi syndrome
5.Gastrointestinal fistula of gallbladder
V. Treatment
1.Surgical treatment of acute cholecystitis
Try to choose elective surgery, especially if the disease duration is more than 3 days; elderly, diabetic, immunocompromised; with clear signs of peritonitis; suspected gallbladder perforation; higher temperature, higher blood picture, infection difficult to control; gallbladder diameter greater than 125px; systemic condition difficult to tolerate emergency surgery, PTBD can be considered.
Surgical modalities
(1) OC
Parallel, retrograde resection
(2) LC
Indications.
Symptomatic gallbladder stones; symptomatic chronic cholecystitis; gallbladder stones >75px in diameter; filled gallbladder stones; symptomatic and surgically indicated gallbladder augmentation lesions; acute cholecystitis in symptomatic remission with surgical indication; single gallbladder polyp >25px in diameter; thick tip, especially in the neck of the gallbladder, age >50 years; multiple gallbladder polyps combined with gallbladder stones; symptomatic, age older than 50 years; gallbladder polyps with clinical symptoms; gallbladder solitary polyps, less than 10 mm, asymptomatic, age younger than 50 years, allowed for observation and follow-up; if the lesion increases or changes in morphology, surgery should be performed; gallbladder polyp-like lesions, with obvious symptoms and recurrent; gallbladder polyps less than 5 mm in diameter asymptomatic patients should be followed up at intervals of 3 to 5 months. Once the lesion is rapidly increasing or symptomatic, surgical treatment is also required.