In recent years, great progress has been made in the prevention and treatment of gallstone disease.
1. In terms of pathogenesis.
Previous understanding was limited to the physiological-biochemical as well as pathophysiological level, but now the causes have been sought at a higher source, i.e., at the genetic level to understand the essential changes in the evolutionary process of human interaction with nature and lifestyle evolution in the genesis of stones, in the hope of finding fundamental solutions for stone prevention. Although we have identified many genetic loci clearly associated with stone formation through genealogical analysis, little is known about how these loci trigger a series of subsequent chain reactions. Therefore, research in this area can only be described as being in its infancy. It is believed that basic research in the next 5-10 years will provide a clearer “roadmap” for stone formation.
2. New epidemiological findings on the epidemiological characteristics of gallbladder stones
(1) More females.
(2) More people older than 40 years old.
(3) More obese people.
(4) More breakfast fasters.
(5) More people with family history.
The authors’ survey of more than 30,000 gallbladder stone patients revealed some new features.
(1) the age of onset extended to less than 40 years old and there was no gender difference
(2) Increased incidence of stones after rapid weight loss.
(3) increased incidence of gallbladder stones with contraceptive use
(4) Increased incidence of stones in people with fatty liver or a history of hepatitis.
(5) Increased incidence of gallbladder stones in those who work in a sedentary position or lack exercise.
(6) The proportion of combined common bile duct stones increases significantly with age. These findings provide the basis for my view, which has been proposed in recent years and is widely accepted in the field.
3. Progress in diagnosis.
Ultrasound is the best way to diagnose gallbladder stones or polyps, but for common bile duct stones, it is best to do MRI to show the entire length of the bile duct. If cancerous gallbladder polyps or gallbladder cancer is suspected, then enhanced CT is preferable. nowadays, routine MRI is advocated for the elderly, as it has been found that the combined common bile duct stones are 30% for those with gallbladder stones at the age of 60, increasing to 60% at the age of 90. In view of the national situation, we recommend MRI for the following conditions.
(1) Those with multiple stones of long duration.
(2) Those of advanced age.
(3) Those with a previous history of jaundice or frequent back pain.
(4) Those with a history of pancreatitis, especially if it is recurrent
(5) frequent episodes of biliary colic, or with fever and jaundice
(6) Those with ultrasound suggestive of dilated common bile duct.
In fact, there are many different imaging tests available, not the most expensive is the best, so both the physician and the patient should choose the test with a clear understanding of the purpose of the test. The physician has the main responsibility in this regard!
4, in the treatment of progress for gallbladder stones, the treatment of three options.
One is to wait and see. For asymptomatic stones, the vast majority currently advocate that no treatment is necessary. The rationale is that many patients are asymptomatic for life. Nowadays, more than 70% of patients with gallbladder stones are found because of “digestive” problems or because of routine physical examinations, when in fact the so-called “digestive symptoms” are atypical symptoms of cholecystitis. Therefore, the old view of defining gallbladder stone symptoms by the presence or absence of typical biliary colic symptoms needs to be re-examined, otherwise it will have an obstructive effect on the development of future gallstone treatment modalities.
Second, removal of the gallbladder. As long as gallbladder stones cause biliary colic, then “everything is done”. This is the code of surgical gallbladder stone treatment and has ruled the surgical community for more than 100 years. The theory is that stones come from the gallbladder, that the gallbladder is a breeding ground for stones, and that removing the gallbladder will eliminate the problem forever. It is not wrong to judge the result: if the gallbladder is gone, gallbladder stones will naturally cease to exist. But for living organisms, especially the human body, the gallbladder cannot simply be seen as a dispensable component, which has been challenged by basic theoretical research in medicine and advances in modern surgical treatment techniques.
Third, bile preservation for stone extraction, so-called rational bile preservation for stone extraction should have.
(1) A patient’s request for bile preservation after explaining the advantages and disadvantages of bile preservation.
(2) Clearly a functional gallbladder after impacted studies.
(3) No recurrence or prevention of recurrence after stone removal is analyzed (e.g., single stone, or multiple stones but similar in size; significant stone susceptibility factors, such as no-feeding habits in the morning, additional food at night, long-term seated work, rapid weight loss, long-term use of birth control pills, etc.).
(4) The treatment method is mild to the body.
The most commonly used methods are.
Small incision lithotripsy; laparoscopic lithotripsy. Although the small incision technique was once left in the cold, it has seen a resurgence due to improvements in technology and is now mostly adopted in Beijing and Guangzhou. It has relatively low technical requirements, as long as there is a cholangioscope on the line, and can be promoted in primary care hospitals. The technical requirements for laparoscopic lithotripsy are relatively high, requiring not only good equipment in the hospital where it is performed, but also extensive experience in minimally invasive surgery, especially with choledochoscopic lithotripsy and minimally invasive suturing skills.