How to treat gallstones?

Guobule CPO physiological health network

References:

Cholecystitis, Gallstones and Fat Diet (Professor Wu Jiayun from Shanghai Medical University)

Cholecystitis and gallstones are common diseases. Most cholecystitis occurs because there are stones in the gallbladder, which block the cystic duct, make bile discharge not smooth, and then bacterial infection occurs, forming cholecystitis. In some patients, there are no stones in the gallbladder, and bacteria enter the gallbladder from the intestine or from the blood circulation, forming cholecystitis. Cholecystitis patients are prone to gallstones because of the changes of bile composition and bile concentration, with bacteria and inflammatory and necrotic substances as the core, so cholecystitis and gallstones often coexist.

Many people know that patients with cholecystitis and gallstones should avoid fat diet. Why? Should fat diet be avoided after gallbladder surgery? Why do some tests and treatments need to eat some fat meals? To answer these questions, we must first understand the anatomy and physiology of gallbladder and bile duct.

The gallbladder is a pear-shaped sac located under the liver. The liver produces about 800 ml of bile every day on average. Except for a small amount of bile flowing directly into the duodenum, most of it is concentrated in the gallbladder 10 times. When the gallbladder contracts, bile flows from the gallbladder into the common bile duct through the cystic duct and enters the duodenum to help digest and absorb food.

When the fat in the diet enters the duodenum, it can stimulate the intestinal mucosa to release a kind of "cholecystokinin" substance, which makes the gallbladder contract and expel bile. However, if there are stones in the gallbladder or common bile duct stones that hinder the normal discharge of bile and the gallbladder contracts strongly, it can cause severe pain and even induce the attack of cholecystitis or cholangitis. When the body's resistance drops, some carriers in the gallbladder will also get sick.

Because most patients with cholecystitis are accompanied by gallstones, patients with cholecystitis and gallstones should avoid fat diet to avoid inducing pain and cholecystitis.

Gallbladder is a place where bile is stored centrally. Patients who have undergone cholecystectomy eat greasy food, and some patients will have diarrhea because there is no concentrated bile entering the duodenum to help digestion. In addition, in patients who have undergone cholecystectomy, the common bile duct often expands to partially replace the function of the gallbladder. If there is something wrong with the compensatory function of bile duct, symptoms such as biliary colic may occur after eating fat diet, so patients after cholecystectomy should also avoid fat diet, at least for 1 ~ 2 years after operation.

In order to understand the function of gallbladder, patients with cholecystitis and gallstones need to take oral drugs such as iodophor or iodophor tablets for cholecystography. Drugs are excreted with bile through the liver and enter the gallbladder. After concentration, the shadow of gallbladder can be shown on the X-ray film. After eating a fat meal, if it shrinks to the original l/3 or l/4 within 30 ~ 40 minutes, it means that the gallbladder function is normal. For patients with good gallbladder function, if there are only 1 ~ 2 stones with the size of 2 cm, extracorporeal shock wave lithotripsy can be used to break the larger stones into particles, and then chenodeoxycholic acid can be taken to dissolve the stones. At this time, the fat diet can make the gallbladder contract, and stones and bile will be discharged into the intestine with feces. Eating a greasy diet at this time is the need of treatment. Therefore, by understanding the anatomy and physiology of gallbladder and biliary tract, we can correctly understand the relationship between cholecystitis, gallstones and fat diet.

Shock wave can cure gallstones (Professor Wang Bingsheng, Shanghai Medical University)

Cholelithiasis is one of the common diseases, and the traditional treatment is surgery. However, many patients hope to eliminate gallstones by non-surgical methods. The advent of extracorporeal shock wave lithotripsy has brought good news to some patients with gallstones. The extracorporeal shock wave lithotriptor made by electro-hydraulic, piezoelectric or magnetoelectric effects can emit high-energy shock waves in vitro, penetrate human skin and tissues, concentrate energy on the stone site and crush the stone. Combined with oral calculus-dissolving and cholagogic drugs, calculus can be dissolved or discharged. This painless treatment is very popular with patients.

However, not all patients with gallstones can be treated with extracorporeal shock wave. The following conditions must be met before this method can be used for treatment: first, gallstones with a diameter of less than 12mm 1 ~ 3, gallstones with a diameter of 13 ~ 20mm/; Secondly, when oral gallbladder contrast agent is taken, the gallbladder has a good function of concentration and contraction, and it is a negative stone with low calcium content, which can penetrate X-ray; Thirdly, the outline of gallbladder and the location of stones can be clearly displayed on the B-ultrasound image of the lithotriptor. In addition, stones found in common bile duct, left and right hepatic ducts and localized intrahepatic bile ducts by cholangiography can also be treated with extracorporeal shock wave lithotripsy if they can be displayed on the B-ultrasound image of the lithotriptor.

Shock wave therapy cannot or should not be performed if. For example, when taking oral gallbladder contrast agent, the gallbladder does not develop, and there are positive stones with high calcium content that cannot penetrate X-ray. The diameter of single gallbladder stone is greater than 25 mm, and there are multiple stones in the gallbladder, gallstones accompanied by common bile duct stones and extensive intrahepatic bile duct stones.

Ursodeoxycholic acid should continue to be taken after shock wave treatment of gallbladder stones, and it should continue to be taken within 3 months after the stones disappear. Pay attention to diet and eat less greasy and cholesterol-rich foods. B-ultrasound should be done regularly to observe whether there is stone regeneration, so as to take corresponding treatment measures in time, such as taking stone-dissolving drugs, re-earthquake treatment or switching to surgery. After shock wave treatment of bile duct stones, cholagogic drugs such as Shudantong, cholagogic alcohol or traditional Chinese medicine should be taken to facilitate the discharge of stones. B-mode ultrasound should be done regularly, and cholangiography should be done when necessary to understand the disappearance of stones. 

Since 1988, 703 cases of gallstones have been treated by EDAP extracorporeal shock wave lithotriptor in Zhongshan Hospital affiliated to Shanghai Medical University. No damage to heart, lung, liver, kidney, pancreas and gastrointestinal tract was found. As long as there are no serious heart, lung, liver and kidney diseases, shock wave therapy can generally be accepted.

Milk can prevent gallstones.

Drinking a glass of whole milk before going to bed can prevent gallstones. Because milk can stimulate the gallbladder and make it empty. In this way, the bile in the gallbladder is not easy to stay and concentrate, and it is difficult to form stones.

What are the types of gallstones?

When you walk into the "kingdom" of stones, you will be amazed at the colorful and different shapes of gallstones. That color, some white as jade, some black as ink, more dark yellow, brown or purple; That shape, some as round as pearls, some as pigeon eggs, some as triangles, polygons, rods and so on; Its hardness, some as hard as stone, some as soft as rice flour, when you cut the stone with a knife, you can see that some are radial with the core as the center, some are layered like tree rings, and some are chaotic; Some stones stand tall and dominate, while others coexist and do not interfere with each other; Some are similar in size and shape, while others are different in size. When you can see all kinds of stones at a glance, you can't help asking: Why do stones that also occur in the biliary system have such a colorful state? The research results of medical scientists show that this is closely related to the cause, composition and location of stones. Doctors classify gallstones from different angles:

(1) According to the components contained in gallstones, they can be divided into three categories:

Cholesterol gallstones: Because bile contains too much cholesterol, it cannot be dissolved and gradually deposits. Most of them are single shot, hard in texture, round or oval. The stone contains about 98% cholesterol, with light yellow or grayish yellow appearance, smooth surface, beautiful luster and radial lines on the section. There are also many stones that are faceted or granular, and X-ray plain films are not developed.

② Bile pigment stones are the most common stones in China. The shape is uncertain, the quality is soft and fragile, the cross section has no core and no bedding, and it is called "Oriental Stone". Stones are composed of bile pigment, calcium salt, bacteria, eggs and so on. Stones vary in size, from sediment to soybean, and their appearance is black or brownish red. They are large in number and small in size, and often flow out with bile to become common bile duct stones.

③ Mixed stones: After stones are formed, cholesterol, bile pigment and calcium salt can be deposited outside the original stones, thus forming gallstones mixed with bile pigment and cholesterol. Due to the different proportion of components, it can present various colors and shapes, generally spherical or polyhedral, with gray, yellow, brown, yellow-green, black and other colors. The cross section is layered and the color of each layer is different. X-rays can often be developed.

According to local reports, mixed stones are the most common stones in China, followed by pigment stones and cholesterol stones. Because gallstones can block all parts, the symptoms causing gallstones are different. This has a lot to do with the size, location and inflammation of gallstones.

(2) According to the location of stones, they can be divided into three types: gallstone, common bile duct stone and intrahepatic bile duct stone:

① Gallbladder stones: mostly cholesterol and mixed stones. Gallstones in the gallbladder generally do not cause jaundice or colic (unless the cystic duct is stuck). At ordinary times, patients occasionally feel full of abdominal distension in the upper middle abdomen or right upper abdomen, and sometimes they may have indigestion symptoms such as belching, souring and abdominal distension. Symptoms will get worse after eating greasy food. There are also some patients who can be asymptomatic for life.

② Common bile duct stones: more common in bilirubin stones. Gallstones can originate from the common bile duct or gallbladder or intrahepatic bile duct. When gallstones get stuck in the common bile duct, patients will feel pain, such as jaundice, chills, fever, gray stool and strong tea-like urine. At this time, when inflammation occurs in the common bile duct, it can lead to serious signs such as high fever and coma. When gallstones move or are discharged from the biliary tract into the duodenum, the jaundice and inflammatory symptoms of patients often subside.

③ Intrahepatic bile duct stones: most of them are bilirubin stones. Intrahepatic bile duct stones account for about 15% of cholelithiasis. Because gallstones are small, sediment-like, and easy to flow down, most of them have choledocholithiasis at the same time. Patients usually have a history of recurrent abdominal pain, chills, fever and jaundice from childhood. This is because gallstones hinder the circulation of bile, which is blocked and cannot be discharged, so it becomes blood, and then the patient's eyes and skin will turn yellow. Doctors call this phenomenon "obstructive jaundice". Also because of biliary obstruction, over time, annoying bacteria will take the opportunity to breed toxins in the biliary tract, causing cholangitis. It can further invade the whole body, causing poisoning, shock, decreased blood pressure, accelerated pulse, apathy, white blood cells exceeding 20.0× 109/L, and body temperature above 39℃. The medical community calls this phenomenon "severe cholangitis". Others can also cause liver suppurative cholangitis and liver abscess through ascending infection.

Were there gallstones in ancient times?

Gallstones may be as old as human history. Gallbladder stones were found in Egyptian mummies (65438 BC+0085 ~ 945 BC). However, judging from its incidence, it is not so common. It is believed that there were clinical descriptions of gallstones before the 4th century BC. After autopsy, the female corpse in Mawangdui tomb in the Western Han Dynasty in China found that the gallbladder contained cholesterol stones and bile pigment stones. Traditional Chinese medicine has long described the clinical manifestations of biliary tract diseases.

How heavy is the biggest gallstone in the world?

The same gallstones are found in different patients, but the number is different, ranging from 1 ~ 2 to thousands, with a bulge. As small as sesame, as big as an egg, or even as big as a bucket.

195212 On February 29th, Charing Cross Hospital in London, England took out the largest gallstone in the world, reaching 6.29 kg.

Department of Surgery, a navy hospital,1981September 26th, a 55-year-old male patient with common bile duct, took out 2 15g of stones.

Do bile duct stones all occur in gallbladder?

No, except for gallstones in the gallbladder, stones may occur in all parts of the biliary system where bile flows, such as the extrahepatic and intrahepatic parts of the biliary tract. The intrahepatic part includes left and right hepatic ducts and branches of hepatobiliary ducts densely distributed in hepatic lobes. The extrahepatic part includes the common hepatic duct, gallbladder, gallbladder neck tube, common bile duct and ampulla. Stones can be produced locally, or they can come from the upper part of biliary tract and flow down with bile.

Why do people get gallstone disease?

Cholelithiasis is a disease of some components of bile in biliary tract (bile pigment, cholesterol, mucus and calcium, etc.). ) under the action of various factors, it precipitates and aggregates to form stones. Stones can occur anywhere in the biliary tract. But most people will not have gallstone disease, because the formation of gallstones requires certain conditions to form stones in the biliary tract. The occurrence of gallstones is related to diet, infection, cholestasis and other factors.

So, what factors in daily life may promote the occurrence of gallstone diseases? ① Long-term intake of high-sugar and high-fat diet can lead to imbalance of three kinds of lipids (cholesterol, lecithin and bile acid) in bile, which leads to cholesterol stones due to oversaturation of cholesterol. ② Contrary to cholesterol gallstones, people who are accustomed to a low-protein and crude carbohydrate diet are prone to cholesterol gallstones. In rural and coastal areas with relatively poor sanitary conditions, the incidence of bilirubin stones is higher. E. coli grows in bile culture, and produces enzymes in the process of reproduction, which exceeds the inhibitory effect of gluconic acid-1, 4- lactone in bile. Hydrolysis combined with bilirubin forms bilirubin stones. The formation of gallstones is a long-term and complicated process, and reasonable diet structure and good hygiene habits can prevent the occurrence of this disease.

Why are stones born in the gallbladder?

Although gallstone is an ancient disease, people have studied it for thousands of years, but so far, doctors can't clearly point out what is the direct cause of gallstone. At present, experts believe that there are roughly the following factors:

(1) The proportion of main components in bile is out of balance: As mentioned above, besides water, solid components include bile salts, cholesterol and lecithin, which are mixed together in a viscous state. As we all know, water and oil are incompatible. Cholesterol is a lipid substance, so it is insoluble in water. Normal cholesterol can be dissolved in bile liquid mainly because there are enough bile salts and lecithin in bile to form colloidal particles. If cholesterol in bile increases, or bile salts and lecithin decrease, the ratio between them is out of balance, and cholesterol is excessive, forming cholesterol crystals. And because they gather together, the more they gather, the more stones are gradually formed. In addition, if the calories (calories) in the diet are too high and the proportion of sugar is too high, it will also inhibit the secretion of bile salts by the liver, and cholesterol will not be dissolved. Another example is when the cholesterol content in the diet (liver, eggs, meat, etc. ), the secretion of cholesterol in bile will increase by 2 ~ 3 times, making cholesterol "supersaturated" in bile. This kind of bile is called "gallstone bile" in medicine. This kind of stone is called cholesterol stone.

(2) Biliary ascariasis: Japanese scholars have studied calcium bilirubin stones removed by surgery and found that 55% of the stones contain ascaris eggs. 465,438+03 gallstones were dissected in a hospital in Qingdao, China, and it was found that 70% ~ 84% of gallstones were formed with ascaris lumbricoides as the core. A head nurse in the Second Hospital of Huzhou saw 10 half of gallstones taken out during the operation, and five ascaris were found in the stones. Under the microscope, groups of ascaris eggs and eggs were found.

Ascaris is parasitic in human small intestine, and there are many kinds of bacteria in small intestine, among which Escherichia coli is the most common. Therefore, Escherichia coli is the most common bacteria attached to ascaris lumbricoides. Moreover, ascaris lumbricoides has a special habit, that is, it drills as soon as it sees a hole and penetrates everywhere. There is a place in the duodenum called duodenal papilla, which is a small hole, and it is the only way for Ascaris to drill into the biliary tract from the intestine. The worm at the tip of the head often tries its best to get into the biliary tract. After ascaris enters the biliary tract, some of them lay eggs in large quantities, others die quickly, rot and turn black, and become segmental residues. Some foreign bodies, such as residues and eggs, are naturally discharged into the intestine under the influence of biliary tract movement and bile flow; Some block the biliary tract, stay in the biliary tract, and gradually form a stone core. At this time, with the entry of ascaris lumbricoides, Escherichia coli takes biliary tract as a hotbed of activity, and takes the opportunity to multiply in large numbers, causing inflammation and edema of biliary tract, increasing and coagulating secretions, and playing the role of forming a stone net rack. Because E.coli can release an enzyme, it comes out to make trouble and scurries around, which greatly destroys the original bound bilirubin in bile and becomes free bilirubin. Free bilirubin combines with calcium in bile to form tiny particles to precipitate downwards. In the process of precipitation, tiny particles gather and deposit with each other through the grid formed by glycoprotein, and are wrapped with foreign bodies as the core. Layer by layer, layer by layer, like snowballing, forms gallstones, which are mixed stones. In the operating room, during the operation, doctors sometimes remove stones from the patient's biliary tract, and half of the ascaris is exposed. Example:

Shao Moumou took out an egg-shaped mixed stone from the common bile duct after operation, and there was half an ascaris on his head. The size of this stone is 2.5cm×1.6cm× 2cm and the weight is 3 1 g..

Someone once did such an interesting experiment that a very thin thread was put into the gallbladder of a rabbit. A few months later, a thin thread turned into a round stone.

(3) Female hormones: Estrogen can directly affect the enzyme system of the liver, reduce bile salts secreted by liver cells, increase cholesterol secretion, interfere with gallbladder contraction function, lead to bile discharge obstruction and cholestasis, and promote the occurrence of gallstones.

(4) Obesity and too little physical activity: the cholesterol conversion rate in obese people is higher than that in normal people, which increases cholesterol excretion in bile and is easy to precipitate and form stones. People who are not interested in sports and have sedentary habits, obesity, loose abdominal wall, thin liver droop, long-term lack of fat in diet and decreased gallbladder muscle tension can cause chronic cholestasis of bile and form stones.

(5) Mental state: Long-term mental stress and depression will cause visceral autonomic nerve disorder, affect gallbladder function and cause cholestasis. Because mental unhappiness will lead to the decrease of disease-resistant white blood cells, thus destroying the function of the immune system in the body. The expert observed a group of men who had lost their wives. In the first 14 months, their white blood cell count decreased significantly.

(6) Heredity: It has been proved that the incidence of cholelithiasis in the next generation is higher than that in the general population, and part of it is mainly due to the low content of congenital cholate in bile, which makes cholesterol very easy to supersaturate and difficult to dissolve and precipitate to form stones.

What are the ingredients in gallstones?

Cholelithiasis is one of the most common diseases that threaten human health, but how gallstones are formed is still a mystery. At present, many scientists are devoted to the study of gallstones, trying to understand the causes and exact process of gallstones and seek effective methods for preventing and treating gallstones. To study the causes of gallstones, we must first find out what components gallstones are made of. The progress of modern analytical chemistry provides a powerful technical means for studying the composition of gallstones. By applying various modern scientific and technological means such as chemical trace quantitative analysis, infrared spectrum, atomic emission and atomic absorption spectrum, electron probe, proton-induced X-ray emission analysis, it is found that the chemical composition of gallstones is very complicated, including cholesterol, calcium bilirubin, calcium carbonate, calcium phosphate, phospholipid, protein, and various metal elements such as copper, iron, manganese, zinc, lead, strontium, titanium, chromium, nickel, etc. Therefore, people call these two kinds of stones cholesterol stones and bilirubin stones respectively. The analysis of the components of gallstones provides a very important inspiration for studying the causes of gallstones. We know that cholesterol and bilirubin are two main components in bile, so people begin to explore under what circumstances and through what process cholesterol and bilirubin that have been dissolved in bile will precipitate out and form stones.

Why are pigment gallstones more common in China and cholesterol gallstones more common in western countries?

Pigmented stones in bile duct account for about 50% of gallstone cases in China. Diseases closely related to pigment gallstones are also called biliary obstruction syndrome in China. This is related to the diet structure and living environment of China people. The dietary composition of China people is mainly from carbohydrates to protein, and the balance between fat and carbohydrates; Coupled with the lifestyle in rural and coastal areas, ascaris lumbricoides is widely parasitic in the human body, and ascaris lumbricoides can bring bacteria into the biliary tract. Bacteria can also flow to the liver through the portal vein and be discharged into the biliary tract, and bacteria in the intestine can still flow back to the biliary tract through the Oddi sphincter. Almost all patients with hepatolithiasis will have biliary tract infection, and the bacterial density in bile is very high. Repeated biliary tract infections reduce the ability of bile duct tissue to resist injury, make bile duct epithelium regenerate badly, increase the incidence of bile duct stenosis and cause cholestasis. Cholestasis is conducive to the proliferation of bacteria and the production of β -glucuronidase in bile, which is an important reason for the formation of pigment stones in bile duct.

In western countries, cholesterol is the main stone, and its diet structure is refined carbohydrates. Two-thirds of gallstones in Japan were originally pigmented gallstones, but in recent years, with the westernization of diet, the incidence of such gallstones has decreased significantly, while cholesterol gallstones have increased significantly. From 65438 to 0984, we analyzed the gallstones in Beijing, and found that the changes of gallstones in Japan were similar, which was related to the decrease of the infection rate of ascaris lumbricoides and the increase of protein and fat content in the diet of Chinese urban residents. Cholelithiasis is rare among African blacks, which Kaplan believes is related to the rich cellulose content in the black diet. However, the incidence of cholesterol stones has increased among blacks who eat western food and have a high standard of living. Therefore, diet and living habits are positively correlated with the types of gallstones.

Who is easy to get gallstones?

Although gallstones are common, not everyone will suffer from gallstones. So, who are prone to gallstones? Scientists have discovered many "risk factors" of cholelithiasis through clinical observation, experimental research and epidemiological investigation. People with these "risk factors" are prone to gallstones. The "risk factors" of cholesterol gallstones include:

(1) Few older teenagers suffer from gallstones. The incidence of cholelithiasis increases with age, so middle-aged and elderly people are more likely to suffer from cholelithiasis than young people. The older you get, the more people suffer from gallstones.

(2) Compared with men, women are more likely to suffer from cholesterol stones, and female patients are generally more than twice as likely as male patients. Women with multiple pregnancies are more prone to gallstones, and women who take oral contraceptives for a long time or use estrogen drugs after menopause are also more prone to gallstones.

(3) Obese people are prone to gallstones. Obese people are overnourished for a long time, and bile contains a lot of cholesterol, which can lead to the formation of cholesterol stones.

(4) Eating too much often, food contains a lot of animal fat, cholesterol and sugar, which is easy to produce cholesterol stones. Western-style diet is the main factor in the formation of cholesterol stones.

(5) Cholesterol stones are easy to occur in some patients with localized ileitis. This is because the diseased ileum can't completely absorb bile acids in the intestine, which leads to excessive loss of bile acids. Similarly, patients who have undergone ileectomy are also prone to cholesterol stones.

Anyone with the above-mentioned "risk factors" should always be alert to the occurrence of gallstones. For example, obese women over middle age often have a feeling of fullness in the upper abdomen and even pain and discomfort after meals. They should go to the hospital in time to check whether there are gallstones. Avoiding overeating and obesity at ordinary times also plays a certain role in preventing gallstones.

What are the top ten inducing factors of gallstones?

According to scientists, gallstones have the following ten inducing factors:

(1) often likes to eat a diet high in sugar, cholesterol and fat.

(2) Patients with biliary parasitic diseases, such as Ascaris, liver fluke disease, etc.

(3) Women with increased hormones.

(4) Obesity and decreased physical activity.

(5) Infection of gallbladder and biliary tract.

(6) Suffering from certain diseases, such as diabetes, nephritis, hypothyroidism and hemolytic diseases.

(7) Long-term use of hypolipidemic drugs: such as atropine and nicotinic acid.

(8) Emotion: long-term mental stress and depression.

(9) heredity.

(10) Operation: such as vagotomy, which destroyed the emptying function of gallbladder; Extensive resection of the distal small intestine can cause bile salts, such as enterohepatic circulation's disorder.

Why can gallstones lead to biliary bleeding?

Biliary bleeding caused by gallstones is often related to infection based on gallstones. There are three pathogenesis: ① diffuse cholangitis of liver and peribiliary inflammation. The main lesion is in the portal area, and the interlobular duct is connected with the interlobular vein, resulting in multiple small bile duct vascular fistulas, and extensive small bile duct hemorrhage is collected into large bile duct hemorrhage. ② Liver abscess type. Multiple biliary liver abscesses converge into large abscesses, and the pus corrodes the branches of hepatic artery or portal vein, leading to biliary bleeding. ③ Hepatobiliary ulcer type. In acute obstructive suppurative cholangitis, the mucosal epithelium of the hepatobiliary duct above the obstruction falls off, forming multiple ulcers, which can penetrate the adjacent hepatic artery and portal vein, causing massive biliary bleeding.

Is magnetic resonance imaging valuable for the diagnosis of gallstones?

Magnetic holography in t? On the weighted image, the gallbladder shows high signal area, in which the stones are low signal shadow, but small stones are often covered by high signal bile, which is difficult to display. It is generally believed that the effect of MRI in detecting gallstones is far less than that of B-ultrasound and ct. Therefore, gallstones are not the indication of MRI examination, and they are not the first choice for examination.

What is the effect of surgical treatment of gallstones?

Although many non-surgical methods have been used to treat gallstones, such as extracorporeal shock wave lithotripsy, oral chenodeoxycholic acid lithotripsy, injection of methyl tert-butyl ether to directly dissolve cholesterol stones, traditional Chinese medicine treatment, etc., some of these methods are still in the clinical research stage, some are not exact and satisfactory, and most of them are only suitable for some patients with gallstones. Therefore, surgical treatment is still the main means to treat gallstones. After surgical treatment, most patients with gallstones will get satisfactory results, their symptoms will be relieved, they can fully recover and live a normal life. However, there are indeed a few patients who will have symptoms of gallstones after operation, and gallstones will recur and even need to be operated again.

What should I do if I find gallstones in the biliary tract after cholangiography with "T" tube?

Clinically, sometimes the biliary tract is carefully explored during surgery, thinking that gallstones have been removed. However, after T-tube cholangiography, bile duct stones are still found, which is often easily complained by patients that doctors are not careful. In fact, although doctors carefully operate and perform cholangiography or choledochoscopy during operation, it is always found that a small number of patients have not removed all the stones in the biliary tract. If stones are found in radiography, the following measures can be taken:

(1) Wait for the stones to be discharged by themselves.

Small stones, sometimes without special treatment, will be discharged into the duodenum through Oddi sphincter.

(2) normal saline flushing

Normal saline is injected into the biliary tract from the T-tube under a certain pressure, and sometimes stones in the biliary tract will be washed into the duodenum.

(3) choledochoscopy for stone removal.

If the placed T-tube is thick, the T-tube can be pulled out at the sixth week after operation, and then the fiber choledochoscope is put into the common bile duct through the fistula of the original T-tube, and then the stone is taken out by the stone removal net.

(4) Endoscopic sphincterotomy

In this method, fiberoptic duodenoscopy is used to examine the common bile duct at the duodenal opening. After seeing the common bile duct nipple at the opening of duodenum, a special nipple sphincter incision knife was sent to the bile duct through fiberoptic duodenoscopy, and then the nipple sphincter was cut off. In this way, the opening of the common bile duct in the duodenum is enlarged, and stones in the bile duct are easily discharged into the duodenum.

(5) stone dissolving method

Some drugs, such as bile salt solution, heparin, methyl tert-butyl ether and so on. All of them are injected through T-tubes, and sometimes stones can be dissolved and discharged.

(6) Surgery

If all the above methods are ineffective, we can only do surgery again to remove the stones.

Why do you find stones after surgery?

Surgery is an effective method to treat cholelithiasis. However, a few years after the operation, some patients have relapsed old diseases, and there may be residual stones or new stones in the bile duct. This condition is called bile duct residual stones. Patients with caesarean section are often unprepared, very scared and at a loss. Why are there residual stones in biliary tract? This is a problem that cholelithiasis patients are very concerned about. According to the statistics of 1983 national academic conference, the incidence of residual bile duct stones in China is 20% ~ 40%, which is much higher than that in foreign countries. There are several reasons:

(1) Causes of the disease itself:

① In the emergency operation, due to the short time, critical condition and poor general condition, it is not suitable for long-term operation and incomplete stone removal.

② There are too many stones, especially multiple stones in intrahepatic bile duct, so it is difficult to take them out at one time.

③ After cholecystectomy, some patients are prone to form new stones, which are called recurrent stones, due to the abnormal bile composition discharged from their liver (called stony bile).

(2) Medical conditions: Due to the limitation of medical equipment or technology, it is impossible to accurately judge the position, size and quantity of stones, which leads to blind stone extraction and easy omission. It may also be due to the improper operation method chosen by the doctor, such as multiple gallstones without ligating the cystic duct first, and the squeezing of the operation makes some gallstones squeeze into the common bile duct.

Why do some patients with cholelithiasis need another or more operations?

The probability of reoperation or multiple operations for biliary tract diseases is the highest among all other diseases in the whole body. Why is this happening? Mainly caused by the following factors:

(1) Sometimes patients are too sick to stand radical surgery and have to take emergency measures. Cholecystostomy or biliary tract incision should be done first, and T tube drainage and decompression should be done to save the patient's life. After 3 months, according to the specific situation of the lesion, choose the appropriate surgical method for the second stage operation.

(2) Due to the variability of biliary anatomy, iatrogenic bile duct injury is easy to occur during operation.

(3) Biliary tract diseases are complex and special, such as intrahepatic bile duct stones and easy recurrence, which lead to the possibility of reoperation of biliary tract.

(4) Before and during the operation, we didn't fully understand the whole biliary system, especially the intrahepatic lesions, missed the lesions and failed to deal with them correctly.

(5) Missed bile duct stones or sphincter stenosis during cholecystectomy.

(6) Chronic cholangitis after operation can lead to secondary bile duct stricture and bile duct? /TD & gt；