Cholecystolithiasis is a common clinical disease, and its incidence rate is 10% ~ 15% in western countries and 4.42% ~ 8.20% in China. The vast majority of these patients may need to face a treatment choice, surgical treatment or drug treatment? If the operation is to remove the gallbladder or to preserve the gallbladder and remove stones? If patients and their families still use search tools such as [Baidu], they may be completely blindfolded. How do you say what has everything? Who should you listen to? There are stones, why do you want to remove the gallbladder? In the earliest days, When a surgeon deals with gallstones, Will retain the gallbladder, Only the gallbladder is removed after fistulostomy, But after the surgery, The recurrence rate of cholecystolithiasis is as high as 80% ~ 90%. Later, After years of clinical anatomy and animal experiments, The hotbed theory is put forward, That is, the gallbladder is a hotbed for the growth of stones. So he pointed out that Only cholecystectomy can cure cholelithiasis. In 1882, he was a 43-year-old male patient who suffered from biliary colic for 16 years. The first open cholecystectomy was performed in the world. As the complications and mortality of cholecystectomy decrease year by year, More and more cholecystolithiasis patients are being cured, After more than 100 years of clinical practice and research, Confirmed that cholecystectomy is a safe operation, It has become a classic operation for cholecystolithiasis, It is widely used in clinic. Later, due to the emergence and continuous development of laparoscopic technology, At present, laparoscopic cholecystectomy has become the [gold standard] for the treatment of cholecystolithiasis. However, cholecystectomy is not a perfect treatment method. In recent years, some studies have also found that cholecystectomy will bring certain effects to patients: the vascular injury rate caused by surgery is 0.2%; The incidence of bile duct injury was 0.2% ~ 0.8%. The incidence of intestinal injury was 0.07% ~ 0.87%. The incidence of dyspepsia, abdominal distension and diarrhea in patients who have lost their gallbladder has obviously increased. Therefore, some scholars have begun to reconsider the value of bile preservation and stone removal. Treating stones without losing an organ is undoubtedly deadly attractive to patients. Is bile preservation and stone removal feasible? Gallbladder-preserving lithotomy is popular with patients, In academia, however, it has aroused controversy. The reason for opposition is that It is reported in the literature that more than 50% of the patients will relapse within 5 years after lithotomy. Even if screening is carried out, Only the functional gallbladder was treated with bile-preserving lithotomy, The recurrence rate of stones is still as high as 39.6% ~ 41.6% 5 years after operation. Supporters believe that, The hotbed theory itself is not necessarily correct, The so-called recurrence rate of stones is because the stones have not been removed, If the cholecystolithiasis is completely and completely removed under the direct vision of choledochoscope, The principle of one-stage suture of gallbladder, The recurrence rate of cholecystolithiasis is only 2% ~ 6% 5 years after operation. However, the clinical evidence supporting these views is not sufficient. After nearly ten years of controversy, In 2011, the Biliary Surgery Group of the Surgery Branch of the Chinese Medical Association published in the Chinese Journal of Digestive Surgery the Expert Consensus on Treatment and Decision-making of Benign Gallbladder Diseases: [Cholecystectomy is the standard treatment for benign diseases of the gallbladder, and laparoscopic cholecystectomy should be the first choice.] [The practical value of cholecystolithiasis needs further study, and it is only suitable for emergency treatment under emergency conditions at present.] Drug lithotripsy, extracorporeal lithotripsy, life-threatening? As for other non-surgical treatment methods for cholecystolithiasis, Such as drug lithotripsy, lithotripsy, extracorporeal shock wave lithotripsy, etc. Because of its low cure rate, And has side effects leading to serious complications, At present, the mainstream medical profession does not recommend clinical application at all. Taking Chinese herbal medicine for stone removal as an example, The treatment process can cause complications such as secondary choledocholithiasis, acute cholangitis, biliary pancreatitis, Repeated stone removal can also cause serious consequences such as injury and stenosis of bile duct sphincter. To take such a big risk in order to preserve the gallbladder, Obviously not a wise choice. Of course, No matter the doctor or the patient, We all hope that there is a kind of medicine with definite curative effect, low recurrence rate, few complications, At the same time, it can preserve gallbladder function as much as possible. However, I am very sorry to tell you that, At the current level of medicine, Treatment that fully meets the above requirements now only exists in advertisements and ideals. Until human beings can fully understand the exact mechanism of gallstone formation, all non-surgical therapies cannot achieve fundamental breakthroughs. Therefore, for patients with obvious symptoms of gallstone, cholecystectomy is the best choice.
