Department of Hepatobiliary Second Branch, Zhujiang Hospital, Southern Medical University
When routinely undergoing physical examinations every year, many people find that they have had gallstones, but they have never had pain and other symptoms. Then they groan: 'What should you do with asymptomatic gallstones? Can you disregard it?' Actually, gallstones No further treatment is required. Symptoms are not the only criteria.
Gallstones, also known as cholelithiasis, including gallstones, bile duct stones and gallbladder, bile duct mixed stones, of which gallbladder stones are the most common. The most common symptom is the upper abdominal or right upper abdominal costal pain, 15 to 30 minutes each time , Can be to the right shoulder, back radiation, sometimes accompanied by nausea and vomiting. Gallstones with inflammation will also appear low fever, chills, sweating and even shock and other symptoms.
Not all patients have symptoms. According to statistics, about 60% of patients do not have significant upper abdominal pain. This depends mainly on whether the stones block the cystic duct, co-infection, and mechanical irritation on the mucosa. Asymptomatic gallstones are usually fewer in number , Large, smooth surface of cholesterol stones, it floating in the gallbladder, it is not easy to suddenly block the cystic duct or fall into the common bile duct, so rarely lead to acute symptoms, and may not even be life-long disease.
Long-term asymptomatic gallstones are generally not harmful to the human body, but once incarcerated or co-infected, they can cause symptoms and severely affect working life. Some small gallstones fall into the common bile duct and enter the duodenum. Can cause intestinal obstruction; Large incarceration, oppression of the biliary tract and its adjacent organs to form internal hemorrhoids, etc. Diameter less than 0.3 cm can be discharged into the duodenum without causing any symptoms, but it is easy to fall into the common bile duct Injuries to the end of the biliary ampulla, resulting in narrow end of the common bile duct, secondary common bile duct stones and gallstone pancreatitis. Mechanical stimulation of gallstones prone to bacterial infection, causing repeated bile duct inflammation, prolonged healing. Cholelithiasis may also Cause gangrene or perforation of gallbladder, causing peritonitis life-threatening, and arrhythmia, septic shock, liver abscess, biliary tract bleeding, liver failure and hepatorenal syndrome and other complications.
In addition, gallstones are also an important pathogenic factor for gallbladder cancer. According to statistics, 80% of gallbladder cancer is related to gallstones, and its incidence is positively related to the size of stones and the length of the disease. According to statistics, patients with stones larger than 3 cm in diameter , 10 times higher than the chance of cancer less than 1 centimeter; 60 years or more and long-term suffering from gallstones, 5% to 10% may suffer from gallbladder cancer. This may be long-term chronic irritation with stones, so that gallbladder mucosal hyperplasia, degeneration and Cancer related.
The following asymptomatic patients are recommended for surgery: Stones larger than 3 cm in diameter, or more than 0.5 cm in diameter; Accompanied with gallbladder polyps larger than 1 cm or thickened in the gallbladder wall; Gallstone wall calcified or porcelain gallbladder; Diabetes mellitus and cardiopulmonary function People with disabilities; located in remote or underdeveloped areas, field workers, children with gallstones, gallbladder stones found more than 10 years and patients need to do other open surgery.
After the first occurrence of biliary colic, most people will relapse within a year. Therefore, patients with cholelithiasis who have biliary cramps or severe epigastric pain after eating greasy food are advised to undergo surgical treatment. Currently, laparoscopic cholecystectomy is the preferred method at home and abroad. Surgery is the mainstay. In addition, gallbladder stones are not recommended for gallbladder surgery.
Some patients may wonder: Just take a stone, why do you have to remove the gallbladder together? This is because the gallbladder needs to be cut open after gallbladder preservation, and then stones and sutures are not only complicated but also easily cause bile flow into the abdominal cavity, causing irritation; Stones will be difficult to remove, resulting in incomplete treatment, easy to relapse after surgery. In addition, gallbladder surgery requires good gallbladder function, a single stone and many other strict conditions, and can not deal with gallbladder polyps with malignant tendencies.
The incidence of gallstones and chronic calculous cholecystitis is related to diet and obesity. Therefore, these patients should try to choose low-fat, low-calorie, low-cholesterol and high-fiber foods in daily life.
