Author: Dr. Tian XiaodongThere are various types of gallstones, and commonly referred to as "gallstones" refers to gallstones, which are diseases caused by stones in the gallbladder

Author: Dr. Tian Xiaodong

There are various types of gallstones, and commonly referred to as "gallstones" refers to gallstones, which are diseases caused by stones in the gallbladder.

In China, the incidence rate of gallstones is about 10%, that is, about one person in every 10 people has gallstones.

At present, there is no effective method to prevent the occurrence of stones, but by adjusting the dietary structure and healthy lifestyle habits reasonably, the development of stones can be reduced or slowed down.

Why do gallstones form?

The causes of gallbladder stones are very complex, and changes in bile composition caused by various reasons can lead to stones.

Currently known factors related to the formation of gallstones include:

1. Age factors

The incidence rate of gallstones increases with age;

2. Gender differences

Research shows that the ratio of male to female onset is approximately 1:2, indicating that women are more likely to develop gallstones, which may be related to differences in sexual hormones;

3. Obesity factors

Obesity is an important risk factor for cholesterol gallstones. The incidence rate of obese people is three times that of people with normal weight;

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4. Dietary factors

Dietary habits are the main factors affecting the formation of gallstones. The incidence rate of gallstones is significantly higher in people who eat low fiber and high calorie foods.

Among them, dietary factors are the easiest to control, so doctors often recommend patients with gallstones to "eat less greasy food", which can not only slow down the occurrence and development of stones, but also effectively reduce the stimulation of fatty foods on the gallbladder, which can reduce the probability of cholecystitis.

What are the manifestations of gallstones?

In fact, most patients with gallbladder stones may not have any clinical symptoms, known as "asymptomatic gallbladder stones", which are mostly found during physical examinations through imaging examinations.

Once symptoms of stones appear, they are often manifested as:

1. Pain in the upper right abdomen (below the right costal margin), with varying degrees, often accompanied by paroxysmal colic and symptoms such as fever, nausea, and vomiting;

2. Generally, pressing on the right upper abdomen (i.e. the position of the gallbladder) can cause tenderness, and sometimes even touch the swollen gallbladder;

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3. Laboratory examination may reveal elevated blood count and slight abnormalities in liver function;

4. Imaging examinations such as B-ultrasound or CT can detect gallbladder enlargement, blurred or thickened gallbladder wall, and stones in the gallbladder, which can confirm the diagnosis of acute cholecystitis.

Many patients with acute cholecystitis experience symptoms such as constipation and abdominal distension during their attacks. Sometimes, abdominal pain may improve after defecation treatment, which can interfere with the diagnosis. At this time, the diagnosis of cholecystitis mainly relies on changes in blood images and imaging changes such as B-ultrasound.

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Patients with chronic cholecystitis have mild symptoms, often manifested as discomfort in the right upper abdomen related to food consumption, sometimes occurring at night. Generally, the blood count is not significantly elevated, and imaging examination can reveal slightly thick or blurred gallbladder walls, as well as signs such as stones inside the gallbladder.

What to do if gallbladder stones are found?

The incidence of gallbladder stones is very high, butMost patients without any symptoms do not require special treatment.

The treatment methods for gallstones include dietary control, medication treatment, and surgical treatment, and the specific method to be taken depends on the patient's specific situation.

1. Dietary control and regular follow-up!

first,Asymptomatic gallbladder stones can be left untreatedMany people carry stones throughout their lives and do not cause symptoms.

For people with high blood lipids or excessive intake of fatty foods, they can adjust their dietary structure and lifestyle habits, eat less greasy foods, exercise more, and sometimes the stones may gradually shrink.

But this group of patients need to undergo regular B-ultrasound examinations (once a year is sufficient, which will be done routinely during physical examinations) to observe the size of stones, gallbladder size, and changes in cyst wall.

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If gallbladder atrophy or thickening of the cystic wall is found during the re examination process, the possibility of gallbladder cancer cannot be ruled out and surgical removal of the gallbladder is necessary.

In another case, when a patient needs epigastrium surgery due to other diseases (such as gastrectomy, partial hepatectomy, etc.), the general doctor will recommend that the gallbladder with stones be removed at the same time (even if it is asymptomatic).

This is because the incidence of cholecystitis in patients increases after surgical intervention, and once cholecystitis occurs after surgical procedures, it increases the difficulty and risk of cholecystectomy surgery.

2. Does medication dissolve stones and endanger life?

Drug treatment for gallstones is targeted at patients with chronic cholecystitis who often feel discomfort in the upper right abdomen.

These patients can temporarily control their symptoms by taking oral anti-inflammatory and cholestatic drugs before making up their minds to remove the gallbladder; Drugs such as ursodeoxycholic acid can also be taken orally to stabilize stones by adjusting the composition of bile acids.

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It should be pointed out that:At present, it is not advocated to use "dissolution" or even lithotripsy for the treatment of gallbladder stones.

Because smaller gallbladder stones are more likely to descend into the common bile duct, and the risk of common bile duct stones is much higher than that of gallbladder stones, the treatment is also more complex.

Therefore, do not misunderstand the promotion of so-called "stone dissolution" or "stone removal" treatment.

3. Is it possible to protect the gallbladder and remove stones?

At the outpatient clinic, the most common question asked by patients is "Can we protect the gallbladder and remove stones

Choledocholic lithotomy has a long history as open cholecystectomy, but it was gradually eliminated at the end of the 20th century due to its high recurrence rate. At present, there is no such operation abroad.

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Research shows that approximately 10% -40% of patients experience recurrence of stones within 5 years after gallbladder sparing lithotomy, so the answer to this question is negative.

If gallstones really need surgical treatment, cholecystectomy is the best choice.

With the progress of medicine, laparoscopic cholecystectomy has been widely used. The safety of surgery has been greatly improved, and the gallbladder function is not necessary for the human body. Most patients can adapt well after resection.

Therefore, as long as the surgical indications are clear, surgical removal of the gallbladder is safe and feasible.

When does it take to remove the gallbladder?

As mentioned earlier, gallbladder stones do not necessarily require removal of the gallbladder, but forCholelithiasis combined with cholecystitis (presenting with clinical symptoms or imaging findings of inflammation) should undergo cholecystectomy.

Cholecystitis is divided into acute and chronic types, and in principle, the gallbladder should be surgically removed.

With the popularization of minimally invasive surgery,Laparoscopic cholecystectomy has replaced the traditional open cholecystectomy as the first choice for the treatment of cholecystitis.

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Due to the presence of swelling and adhesion around the gallbladder during the onset of acute cholecystitis, the anatomical level is unclear, which increases the difficulty and risk of laparoscopic surgery.

Therefore, at present, most people do not advocate cholecystectomy at the acute stage, but take conservative treatment to get through the acute inflammatory stage, and then perform laparoscopic cholecystectomy after the inflammation completely subsides (about 2 months after the acute attack).

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Of course, experienced surgeons can selectively perform laparoscopic cholecystectomy in the acute phase, but the corresponding operation risk will be significantly increased.

Some patients with chronic cholecystitis or gallstones after an acute attack, due to their mild clinical manifestations, are reluctant to remove the gallbladder with a sense of luck.

However, doing so is equivalent to burying a "ticking time bomb scenario" on oneself. Repeated cholecystitis itself increases the incidence of gallbladder cancer, and the canceration rate increases sharply with age.

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On the other hand, the mortality rate and treatment difficulty of acute cholecystitis in the elderly have greatly increased, and benign diseases that are already well treated may be fatal in the elderly.

Therefore,For patients with symptomatic gallstones (especially those with recurrent acute cholecystitis), gallstones with thickened gallbladder wall and gallbladder atrophy shown by imaging, it is advisable to choose the appropriate time to accept cholecystectomy.

What to pay attention to after cholecystectomy

The function of the gallbladder is to store, concentrate, and expel bile, assisting in the digestion and absorption of fatty foods.

After removing the gallbladder, the above functions will definitely be affected, mainly manifested in diarrhea after consuming a large amount of fatty foods.

But as time goes on, the body will dilate the bile ducts to partially compensate for gallbladder function. Generally, it will be able to digest and absorb food normally after 2-3 months.

Therefore, after cholecystectomy, we should pay attention to low-fat diet, eat less greasy, fat meat, egg yolk and other foods, and do not overeat, so as to form a good eating pattern.

Summary:

Gallstones are common,

Surgery is only performed when symptoms appear;

It is not advisable to protect the gallbladder and remove stones,

Dissolved stone and crushed stone should be cautious;

Try your best to prevent acute attacks,

Endoscopic cholecystectomy is the first choice;

Cholecystectomy is not scary,

Eating less greasy food is the key.

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