With the rapid development of science and technology, China’s medical technology has been developed rapidly and great progress has been made in the treatment of gallbladder stones. Gallbladder stones are a common clinical disease, and in recent years, the incidence of gallbladder stones has been increasing, which has attracted great attention. The ideal treatment method for clinical treatment of gallbladder stones is laparoscopic minimally invasive cholelithiasis treatment, which has remarkable clinical effect and is widely recognized by patients. This paper analyzes the treatment method of laparoscopic minimally invasive biliary lithotripsy and discusses the advantages of its clinical use.
Gallbladder stones are a common disease in clinical practice, and the incidence of this disease is developing at a younger age, posing a serious threat to people’s health. The traditional treatment for gallbladder stones is cholecystectomy, but after surgery, patients often suffer from complications such as abdominal distension and diarrhea, dyspepsia, bile reflux gastritis, and an increased prevalence of common bile duct stones, and in severe cases, colon cancer may be induced, with a poor prognosis.
With the development of minimally invasive technology, laparoscopic minimally invasive gallbladder stone extraction is used in the treatment of gallbladder stones, and the surgery is carried out on preserving the original function of gallbladder, which has a positive effect on the recovery of patients.
1. Analysis of gallbladder stone lesions
In recent years, the number of patients visiting hospitals for gallbladder stones has been increasing. The causes of gallbladder stones are complex, mainly due to a combination of cholesterol and/or bile pigment supersaturation in the bile, nucleation factors, and gallbladder dysfunction.
Ageing, high-fat and high-cholesterol diet, hyperlipidemia, and hyperglycemia can cause a decrease in bile acid salts in the bile and an increase in cholesterol saturation, resulting in lithogenic bile and gallbladder cholesterol stone formation. Bacterial metabolites, infection-induced microvesicle aggregation and fusion, glycoproteins and free radicals in bile during inflammation are all nucleating factors in stone formation, causing bilirubin calcium aggregation;
Repeated biliary tract infections can disrupt the gallbladder function and affect the contraction of the gallbladder, and the formation and dilation of the Rochefort sinus in the gallbladder wall, which can cause bile stasis and thus stone formation. In the early stages of gallbladder stone development, the degree of damage to the gallbladder tissue is relatively small and there are no significant functional abnormalities, but if left untreated, the stones increase in size and number, and as the time inside the gallbladder increases, the function of the gallbladder is seriously affected.
Gallbladder stones then induce gallbladder atrophy, acute cholecystitis or even cause gallbladder cancer. The initial clinical symptoms of gallbladder stones are not significant, but as the condition worsens, the clinical symptoms become more and more significant, and timely treatment is the key to improve the clinical efficacy.
2.Laparoscopic minimally invasive lithotripsy surgical method analysis
The first step is to establish a pneumoperitoneum by puncture. After a pneumoperitoneum is routinely established at the umbilicus with a pneumoperitoneal needle and a 10mm Trocar is placed, the laparoscope is inserted into the abdominal cavity and the gallbladder is carefully investigated, such as the shape and location of the gallbladder, especially to see whether there are adhesions and to determine whether biliary surgery can be performed.
Under the condition that there is no abnormality of the gallbladder, a small incision is made at the projection of the gallbladder base under laparoscopic surveillance, and the base of the gallbladder is lifted to the abdominal wall with a non-invasive grasping forceps from the incision site. The bottom of the gallbladder was incised after protecting the incision with sterile gauze, and then the choledochoscope was placed, bile was withdrawn, and saline was instilled into it for cleaning [1]. The stones are observed and the cyst wall is observed for any lesions, and the stones are completely removed under direct vision of the choledochoscope and checked for any residuals, and after ensuring that there are no any residuals, suturing is performed.
The operation is relatively simple, but there are still some things that need to be paid attention to in order to ensure the effectiveness of the procedure. In order to avoid the leakage of debris, mesh basket stone extraction is the only way to remove stones under the scope, and objects such as forceps and scrapers to remove stones will make them fall elsewhere. The use of a choledochoscope for stone extraction does not allow its smooth removal [2]. If the stone is too large, it is removed by breaking it up with a therapeutic instrument or by discharging it by incising the base of the gallbladder in situ in the abdomen and placing it in a plastic specimen bag.
After the removal of stones, the examination is carried out. If there are bile sludge or debris during the examination, the bile sludge remaining in the bile duct should be removed. The main purpose of doing choledochoscopy is to ensure that there are no stones left in the bile duct and to clarify that bile enters the gallbladder through the opening of the bile duct.
Treatment with laparoscopic minimally invasive biliary lithotomy can effectively preserve the function of the gallbladder, and preserving the function of the gallbladder is also the focus of the procedure. The gallbladder is an essential and important part of the body, first of all, it has not only immune and digestive functions, but also the ability to concentrate and store bile [3]. The gallbladder stores nearly 30 times more concentrated bile, which facilitates the digestion and absorption of high-fat foods when a person eats them.
When cholecystectomized patients eat high-fat food, the bile secretion is relatively insufficient, resulting in inadequate emulsification and absorption of the fat in the food, which in turn leads to obvious indigestion symptoms such as abdominal distension and diarrhea. According to the survey statistics, most patients with cholecystectomy have a significant decrease in the dilatation power of the stomach and esophagus after surgery compared with that before surgery, which makes their absorption function disappear after surgery, and bile reflux into the stomach for continuous excretion.
Secondly, performing cholecystectomy increases the risk of hepatic duct injury, biliary tract injury, gastrointestinal injury and vascular injury. In contrast, minimally invasive cholecystectomy is performed mainly in the fundic incision and intra-biliary stone extraction, which greatly reduces the risk of side injuries associated with the above-mentioned cholecystectomy surgery. Furthermore, gallbladder stones often occur secondary to cholecystectomy, and according to the analysis of recent clinical cases, the postoperative recurrence rate of common bile duct stones in patients with previous gallbladder stones and cholecystectomy is much higher than that of patients with simple gallbladder stone preservation but stone extraction surgery [5].
3. advantages of laparoscopic minimally invasive bile stone extraction
3.1 Advantages of the existence of surgical methods
Patients undergoing laparoscopic surgery must be able to undergo general anesthesia and tolerate carbon dioxide and pneumoperitoneum. With the continuous development and improvement of laparoscopic surgical approaches, there are more types of systems for laparoscopic surgery, and the single-hole pneumoperitoneum-free laparoscopic surgical system does not need to be built on a pneumoperitoneum [5], which makes it possible to perform minimally invasive laparoscopic surgery in patients who cannot tolerate pneumoperitoneum. In contrast, open laparoscopic surgery is characterized by the use of special medical devices during surgery, which allows the medical staff to perform the surgery with a clear view and visualize the changes in the patient’s condition.
In the course of surgery, if the patient’s condition is found to be complicated, the surgical incision can then be extended appropriately according to the patient’s condition. Because of open laparoscopic surgery, only one incision is made, and for this reason, the correct incision site is crucial. In general, when choosing the surgical incision, the incision site is the site where the midline of the patient’s right clavicle and the location 25px below the rib cage intersects with it as the incision point, and the incision is positioned here to ensure that the incision is located exactly where the bottom of the gallbladder needs to be incised to correspond with each other.
In this case, the incision is more deviated and the base of the gallbladder can be corrected within the area of the incision by pulling. The presence of a traction line in the upper part of the peritoneum facilitates the exposure of the base of the gallbladder, which is especially important in patients with a deeper gallbladder and body surface or a thicker abdominal wall.
In patients with ectopic gallbladder, it is necessary to select the gallbladder with the aid of a carrier mirror revealer during surgery, otherwise it is difficult to find the gallbladder, and the carrier mirror revealer can be used to pass through the bottom of the gallbladder and reach the cystic cavity for observation. The residual amount.
3.2 Advantages of traditional surgical methods
Advantage one, laparoscopic minimally invasive biliary stone extraction is also applicable in patients who cannot tolerate pneumoperitoneum, for example, patients with gallbladder stones with cardiopulmonary dysfunction and patients with combined ventral hernia.
The second advantage is that during the procedure, the surgeon can operate in an environment with a clear view of the gallbladder and its tissues, all of which can be seen in the surgeon’s line of sight, making it easier to operate. More importantly, it is safer to squeeze the stones in the cystic duct in the direction of the cystic duct.
Advantage 3: During the procedure, if adhesions are found around the gallbladder, or if the location is deep, the incision can be extended directly [9]. Advantage 4, the surgeon can see the tissue around the gallbladder very intuitively under the screen view, check whether there are stones in the abdominal cavity, and if they exist, do the treatment in time to avoid the re-establishment of the pneumoperitoneum [10].
4. Outlook
Laparoscopic minimally invasive biliary lithotripsy is widely recognized for its simplicity and low trauma to the patient, and biliary preservation is the focus of the procedure [11]. Biliary preservation is not an unfamiliar concept in clinical surgery, and in the treatment of gallbladder stones, treatment with cholecystostomy biliary preservation, which is in a procedure that preserves the function of the gallbladder, has been discontinued for this reason because the procedure fails to remove all the stones and has a high recurrence rate in patients after the completion of the procedure.
Later, other methods of gallbladder preservation were adopted, such as percutaneous cholecystoscopy, contact lithotripsy and extracorporeal shock wave lithotripsy, which can remove all the stones and preserve the function of gallbladder.
With the rapid development of minimally invasive technology in China, laparoscopic technology has been widely used and applied to the treatment of gallbladder stones, and laparoscopic minimally invasive lithotripsy treatment is carried out on the basis of gallbladder preservation. It is a less invasive procedure for the patient.
However, this technique requires a high level of skill, and China is still in the early stages of research on laparoscopic minimally invasive biliary lithotripsy, and there is a lack of experience in treatment. The use of laparoscopic minimally invasive biliary lithotripsy has to pay attention to some problems during the operation in order to improve the rate of surgical function and reduce the rate of postoperative complications.
For this reason, major hospitals in China should pay attention to the technical training of laparoscopic minimally invasive biliary lithotripsy, and the relevant hospital departments should train the doctors responsible for laparoscopic minimally invasive biliary lithotripsy. Since the technology of laparoscopic minimally invasive biliary lithotripsy in China is relatively backward compared with that in developed countries, in the study of laparoscopic minimally invasive biliary lithotripsy training, we can consider arranging medical personnel to study abroad to improve the hospital In order to improve the overall level of operation, we will strive to achieve the best laparoscopic minimally invasive biliary lithotripsy and improve the clinical efficacy.
As people’s demand for quality of life improves, patients are more and more willing to preserve their gallbladders, and laparoscopic minimally invasive cholecystectomy is expected to become an alternative treatment to cholecystectomy for gallbladders with good function.