Professor Zhang Baihe from the Third Affiliated Hospital of the Second Military Medical University
In the first half of this year, Ronaldinho had a cholecystectomy because of gallstones. After the operation, she recovered well. But she is always worried that although the gallbladder is small, it is also a part of the body and has its special functions. Does cholecystectomy have any adverse effects on the body? How should patients after cholecystectomy maintain themselves?
Cholecystectomy is the main method to treat gallstones, and it is also one of the most common operations in abdominal surgery. Severe acute cholecystitis, recurrent chronic cholecystitis and symptomatic cholecystolithiasis all require cholecystectomy. The development of medicine and the improvement of surgical techniques have greatly improved the safety of surgery. However, any experienced doctor will not treat cholecystectomy as a simple minor operation. Long-term clinical experience tells us that cholecystectomy has certain negative effects on the body.
Bile excretion dysfunction
Under normal circumstances, the gallbladder has the functions of storing and concentrating bile and adjusting the pressure in the biliary tract to adapt to people's eating habits. Normal liver cells continuously secrete bile, which is stored in gallbladder through cystic duct, and the concentration is about 10 times. After eating, the gallbladder contracts and a large amount of bile is discharged into the biliary tract to facilitate the digestion and absorption of fat. After cholecystectomy, the pressure in the biliary tract is mainly maintained by the secretory pressure of hepatocytes, which makes Oddi sphincter open for a long time and bile continuously enters the intestine. The amount of bile in digestive period is relatively insufficient, and the bile injected into biliary tract in non-digestive period can not play a role, which has a certain impact on the digestion and absorption of food. If you eat too much fat, due to the loss of gallbladder and the relative shortage of bile, it will lead to fat indigestion, diarrhea and lack of fat-soluble vitamins.
Effect on digestive system
After cholecystectomy, bile reflux can lead to inflammatory changes of gastric mucosa; Bile diarrhea is caused by the increase of bile acid concentration in intestinal cavity; In some cases, bile may flow back to the pancreatic duct due to the high internal pressure of bile duct, which may lead to biliary pancreatitis. But the probability of these three situations is not great. Generally speaking, cholecystectomy will not bring too much obstacle to the digestion and absorption function of human body.
Complications after cholecystectomy
(1) pulmonary infection
Mainly related to surgical trauma and general anesthesia. After operation, help the patient turn over, pat his back and encourage coughing and expectoration.
(2) jaundice
The main reasons may be: ① secondary stones in the common bile duct or small stones in the gallbladder are squeezed into the common bile duct due to surgical operation; ② Related to drugs, blood transfusion and hemolysis; ③ There may be bile duct injury.
(3) Bile fistula
The common causes are injury of accessory hepatic duct, common hepatic duct or common bile duct, or slippage of ligation line of cystic duct stump. Once the diagnosis is clear, it should be dealt with in time.
After cholecystectomy, it does have some disadvantages to the body, and postoperative recovery is very important. Besides paying attention to rest, it is also necessary to control diet. The main reason is that bile excretion function has changed compared with that before operation. In the near future after cholecystectomy, patients should avoid eating high-fat food, and the diet should be light, with less oil, high protein (no egg yolk) and high calories as the principle. You can eat less and eat more meals, especially don't eat too much animal fat food at one time, such as fat meat and pig's trotters. After 3 ~ 6 months, you can gradually add a small amount of fat to your diet for many times, with no indigestion such as abdominal discomfort and diarrhea as the standard. After a period of adaptation, there will be no reaction to fatty foods. In addition, it is absolutely necessary to have a normal physical examination and know your health status in time.
Although cholecystectomy has many effects on human body, if there are indications for cholecystectomy, we advocate that patients should choose surgery without hesitation. After the operation, correct self-care under the guidance of a doctor is believed to restore health quickly, thus minimizing the negative effects of the operation.
cholelith
Cholecystitis is often accompanied by gallstones, which can block the cystic duct and cause inflammation.
Cholelithiasis is a small solid substance formed by precipitation of inorganic salts and other impurities in bile, which is deposited in gallbladder, intrahepatic and extrahepatic bile ducts, often leading to obstruction of a certain part of bile duct and causing pain.
Nutrient source
The cause of cholelithiasis is still not very exact. At present, many factors related to it are known, one of which is diet and nutrition.
1, long-term high-fat diet. High-fat diet, especially foods with high cholesterol, such as animal brain, liver, kidney, egg yolk, etc., will lead to the increase of cholesterol in blood and bile, which is easy to produce gallstones. In addition, long-term high-fat diet is easy to make people obese, coupled with poor exercise, which leads to decreased gallbladder muscle tension, delayed gallbladder emptying, cholestasis and stone formation.
2. Long-term low-fat diet. Low-fat diet will affect the body's absorption of nutrients, cause bile deficiency and malnutrition, and also cause gallstones.
3, love sweets or excessive intake of food with high sugar content. Refined rice and flour will accelerate the accumulation of cholesterol, resulting in the imbalance of cholesterol, bile acid and lecithin in bile. Too much sugar will turn into fat, which will make people fat and increase the risk of stones.
4. Long-term drinking. Long-term drinking will lead to liver fibrosis, cirrhosis, fatty liver and other diseases, so that bile emptying is blocked and silted, which is also one of the incentives for gallstones.
5, eating habits are unreasonable. People who skip breakfast for a long time are prone to gallstones. Because I didn't eat breakfast, I had a long fasting time, and my bile secretion decreased, which was easy to deposit in my gallbladder. Over time, gallstones will form.
6. Drink too little water. Drinking less water will lead to thick blood and bile, which will produce gallstones after a long time.
cardinal symptom
1, "asymptomatic" gallstones (quiet gallstones): asymptomatic means that there is no biliary colic, almost asymptomatic, or even undetected for life. Sometimes only slight abdominal distension, dull pain, discomfort, belching, etc. And the symptoms are more obvious after eating greasy food, which is easy to be regarded as "hepatitis" and "gastritis". Physical examination of the right upper abdomen, mild tenderness, no muscle tension, palpable when gallbladder hydrops.
2, biliary colic: severe colic in the right upper abdomen, radiating to the shoulder and back, accompanied by nausea and vomiting. It is caused by stone incarceration, and sometimes the symptoms disappear due to body position change. Otherwise, secondary infection, suppuration, jaundice, perforation, fever, peritonitis, shock and other symptoms will occur. Gallbladder colic mostly occurs after a full meal or greasy food, and a few patients occur at night.
3, jaundice: stones falling into the common bile duct or stones embedded in the neck of the gallbladder can cause obstructive jaundice.
Causes of women's susceptibility to gallstones
Cholelithiasis is a common disease, especially in the age group of 20 to 25 years old. Another feature of gallstones is that "women are more important than men". According to statistics, the incidence of gallstones in women is 2 to 4 times that of men. The main reasons for gallstones "valuing women over men" are:
1, prefer quiet and less movement. Many women, especially middle-aged women, often spend more time at home and less exercise and physical labor. Over time, the contractility of their gallbladder muscles will inevitably decrease, and bile emptying will be delayed, which will easily lead to cholestasis and cholesterol crystallization, creating conditions for the formation of gallstones.
2, physical obesity. Many women usually like to eat drinks or snacks with high fat, high sugar and high cholesterol. The direct consequence of this hobby is getting fat, and obesity is an important basis for gallstones. Studies have shown that the incidence of gallstones is five times higher in people whose weight exceeds the normal standard 15%.
3. Don't eat breakfast. I'm afraid more modern women skip breakfast than eat breakfast. Long-term skipping breakfast will increase bile concentration, which is conducive to bacterial reproduction and easy to promote the formation of gallstones. If you insist on eating breakfast, you can promote the outflow of some bile, reduce the viscosity of bile stored overnight and reduce the risk of gallstones.
4. Multiple pregnancy. Women's biliary tract function is prone to disorder during pregnancy, which leads to weak contraction of smooth muscle and bile retention in gallbladder. In addition, the cholesterol in the blood during pregnancy is relatively high and easy to precipitate, and the probability of gallstones is greatly increased.
Diet regulation
The purpose of diet therapy is to inhibit the formation of stones and alleviate the pain caused by stone obstruction. The principle of diet therapy is:
1, the heat supply should meet the physiological needs, but to prevent excessive, generally 1500 ~ 2400 kcal.
2. Limit fat and avoid stimulating gallbladder contraction to relieve pain. Before and after the operation, the fat in the diet should be controlled at about 20 grams, which can be slightly increased with the improvement of the condition to improve the color, aroma and taste of the dishes and stimulate the appetite. Avoid greasy, fried, fried and fatty foods, such as fat pork, mutton, stuffed duck, fat goose, butter, cakes and cream cakes.
3. Control the intake of high cholesterol food to reduce the obstacles of cholesterol metabolism and prevent the formation of stones.
4. Complement protein. Sufficient protein can make up for the loss, maintain nitrogen balance, increase immunity, and help to repair liver cell damage and restore normal function. The daily supply of protein is 80 ~ 100g, and the suitable foods are fish, shrimp, lean meat, rabbit meat, chicken and tofu.
5. Supplement vitamins and inorganic salts. Choose foods rich in calcium, potassium and iron. It is also important to supplement vitamins C and B and fat-soluble vitamins.
6. Eating more fiber-rich vegetables and fruits can reduce the formation of gallstones.
7. Quit all spicy food and spices.
Nutritional diet
Chicken gizzard porridge
[Formula] Japonica rice 100g, Endothelium Corneum Gigeriae Galli 6- 10g, and proper amount of sugar.
[Production] First, clean the endothelium corneum Gigeriae Galli, drain the water, stir-fry in a pot with slow fire until brown, and grind into fine powder. Then wash the japonica rice, put it in a pot, add 800 ml of water and cook it with slow fire until the rice soup is not thick. Add chicken gizzard-membrane and sugar and cook together. After boiling, stop the fire when the porridge soup is sticky. It should not be cooked for a long time
[Usage] Take it twice a day for breakfast and dinner. Warm clothes are better than cold clothes.
【 Efficacy 】 Tonifying the middle energizer, benefiting the stomach, relieving pain and removing stones from fossils.
Patients with gallstones should eat walnuts.
Medical research has found that mucin in food combines with calcium ions and free bilirubin in human bile to form the crystal nucleus of gallstone scaffold, thus forming gallstones.
There is a kind of pyruvate in walnut kernel, which can prevent mucin from combining with calcium ions and unbound bilirubin, make it dissolve, fade and excrete.
Therefore, eating more walnuts is beneficial to the prevention and treatment of cholelithiasis. Eat four large walnuts or a dozen small walnuts every day on average, without interruption, and the symptoms of cholelithiasis patients can be obviously alleviated after taking it for 3 months. It can be restored after half a year. Patients with gallstones may wish to have a try.
Suggestions on the conditioning of nutritional products;
■3 times dosage: milk thistle dandelion tablets, lecithin, vitamin B group.
■2 times dosage: deep-sea fish oil and vitamin C.
Beijian Milk Thistle Dandelion Tablet: It can protect liver and gallbladder, regulate bile secretion and help digest fat.
Hardening lecithin: hydrophilic and lipophilic, it can emulsify fat, prevent stone deposition, keep cholesterol in bile liquid and prevent gallstones from forming.
B vitamins: enzymes that synthesize metabolism and promote metabolism.
Vitamin C: It has the functions of antioxidation and detoxification, and participates in the metabolism of cholesterol. If it is lacking, it will lead to gallstones.
Bianjian deep-sea fish oil: regulate blood fat, help digest fat, regulate blood fat, and reduce cholesterol and triglycerides.
Treatment and prevention of gallstones
Lecithin capsules, the "digestive army" of gallstones, decompose and absorb cholesterol, liquefy cholesterol in bile, and prevent and dissolve gallstones.
The treatment and prevention of gallstones can be removed by drugs (dissolving stones), surgery (removing stones) or diet therapy (controlling the formation of gallstones) and the latest ultrasonic vibration method.
Basically, if there are no conscious symptoms and there is no serious harm to health, surgery should not be considered, but if there are complications or serious situations. The gallbladder should be removed so as not to endanger life.
People in China are eating better and better, which makes gallstones easily entangled without knowing it. People in China should pay attention to their daily diet, limit animal fat intake and maintain their weight. More importantly, regular health check-ups. Gallbladder X-ray photography is the most useful method to diagnose gallstones. At present, abdominal ultrasound examination is the most commonly used and painless method. Using the echo reflection of sound waves to judge whether there are stones, so as to achieve the purpose of early treatment.
Because gallstones are closely related to physical fitness and diet, if you are consciously a high-risk group or a lover of westernized diet. Once symptoms appear, you must be vigilant. Daily reaction of gallstones: self-examination of daily life style is the first step towards health.
Please pay attention to the following living standards:
1. Maintain ideal weight.
2. Keep the habit of exercise.
3. Pay attention to food safety, hygiene, timing and quantification.
4. Overeating is absolutely forbidden.
5. Avoid sitting and working for a long time.
6. avoid being too tired.
7. Don't wear tight clothes that tighten your chest and abdomen.
8. If you have constipation symptoms, you must actively treat them.
Dietary therapy for gallstones
1. Eat more high-fiber foods, such as vegetables, fruits and whole grains.
2. Limit cholesterol intake. Never eat foods rich in cholesterol such as viscera and egg yolk.
3. More vitamin K supplements, such as spinach and cauliflower, are rich in content.
4. Fasting foods that are easy to generate gas, such as potatoes, sweet potatoes, beans, onions, radishes, soft drinks, and acidic fruit juice, coffee, cocoa, etc.
5. Milk is limited to skim milk.
6. eat more yellow-green vegetables rich in vitamin a.
7. Use less frying and frying when cooking food, and use more boiling, stewing and steaming.
8. Fasting soup and mayonnaise with high fat content.
9. Try to be light in taste and moderate in seasoning.
10. Avoid eating processed foods and foods with high sugar content.
======================
Treatment of Gallbladder Calculi with Oral Medicine and Lithotripsy
1937, Newurdge successfully took mixed bile acids orally for the first time.
The treatment of 2 patients with gallstones pioneered the dissolution of oral drugs.
The real establishment of this therapy was in the 1970s. 197 1 year etc.
It has been found that oral chenodeoxycholic acid (CDCA) can reduce the bile of patients with cholelithiasis.
The saturation of cholesterol. Later, Sugata discovered ursodeoxycholic acid (UD2
CA) has no less stone dissolving effect than CDCA, and has less side effects because
It was quickly applied all over the world. 1979, Bell and Dolan used mint.
The mixture of alcohol, menthone and other annular single ointment was used to treat CS patients and achieved good therapeutic effect.
Since then, many countries have done a lot of research on its stone dissolution mechanism and effect.
Research shows that the clinical effect of taking CDCA alone is not satisfactory.
The hepatobiliary acid produced by CA under the action of intestinal bacteria is hepatotoxic and should be taken for a long time.
3 %CDCA has potential lipid metabolism changes in atherosclerosis (3).
At present, oral litholysis is not ideal because of the long course of oral litholysis.
The cost is high, the curative effect is not good, and patients have various toxic reactions during the treatment.
The recurrence rate is high.
3. Inject drugs to dissolve stones for treatment.
As early as 189 1, Walker used ether to dissolve stones in the human body, but it was made by
When the boiling point of ether is lower than the body temperature, it vaporizes after entering the human body, generating high pressure to treat patients.
Patients with severe abdominal pain are not widely accepted. In recent years, due to the imaging technology in
With the rapid development of medical field, percutaneous cholangiopancreatography has become more feasible.
It is more accurate to identify and locate stones, which provides a necessary premise for injecting drugs to dissolve stones.
According to the different types of gallstones, the treatment methods of injecting drugs to dissolve gallstones can be divided into
Used for:
Treatment of (1) cholesterol gallstones with 1979 hoffmann group.
Monooctyl ester (Mo) is a good cholesterol dissolving agent, which can dissolve cholesterol.
The degree is 12g/ 100ml, which is a semi-synthetic vegetable oil.
It is broken down into glycerol and octanoic acid. Animal experiments show that the toxicity of the latter is local.
Stimulation can cause mild or severe inflammation of gallbladder, bile duct and gastrointestinal mucosa.
Mucosal ulcer, etc. (4). 1980 Mayo et al. applied Mo to human body dissolution for the first time.
After the successful treatment of gallstones, many gallstone researchers went deep into it.
The clinical results show that Mo's treatment experience is: it must be CS, but not.
Calcification, bile in bile duct should be exhausted as much as possible, and drug circulation and perfusion should be stirred; But what about the curative effect
This is common and has complications.
(2) Litholysis Treatment of Bile Pigment Stones Because Bile Pigment Stones have poly
The structural characteristics of bulk are complicated, and there is no good dissolving agent, which is used in clinic and
Most experimental studies are calcium ion complexing agents, among which sodium ethylenediamine tetraacetate (Na
Sodium hexametaphosphate (Na-HM P) and D- sodium citrate.
-L, there is no new report on the treatment of cholelithiasis in recent years, and the prospect remains to be seen.
In the discovery of new solvents, it is necessary to be able to dissolve stones of various properties without major side effects.
Function.
4. Treating gallstones with traditional Chinese medicine
In recent years, Chinese medicine has made gratifying achievements in treating gallstones. Traditional Chinese medicine treatment
Gallstones are mainly composed of soothing the liver and benefiting gallbladder, dissolving stones, promoting qi circulation and relieving pain. Wang Ling (5) adopted.
Cholecystitis and cholelithiasis are treated both internally and externally, and the prescriptions are Bupleurum, Polygonum cuspidatum and Ling Wei.
Fairy, Fructus Aurantii, Endothelium Corneum Gigeriae Galli each 15g, Radix Curcumae, Radix et Rhizoma Rhei, Cortex Magnolia Officinalis each 9g, Herba Lysimachiae Christinae and Rhizoma Phragmitis.
30g each, daily 1 dose, 2 doses per severe day. Results Among 98 cases, 28 cases were cured.
=====================
Treatment of gallstones
Cholelithiasis with discomfort and pain in the right upper abdomen is a common disease in middle-aged and elderly people. With the increase of age, the incidence rate is also increasing. Because stones are formed and exist in different parts, they are often divided into gallbladder stones, bile duct stones and intrahepatic bile duct stones. Stones in these parts often coexist with biliary tract infections, which are mutually causal. How to choose the best treatment plan, it is important to fully understand the condition through clinical diagnosis and physical examination, make an accurate diagnosis, determine the location, size and quantity of gallstones, and then choose different treatment plans according to different situations.
There are two methods to treat cholelithiasis in clinic. One is surgical treatment, that is, removing the diseased gallbladder and taking out the stones. The other is non-surgical treatment, that is, symptomatic treatment of traditional Chinese and western medicine, extracorporeal shock wave lithotripsy and litholysis. These two treatments have their own advantages and disadvantages.
Surgical treatment is an important method to treat cholelithiasis, but the surgical indications must be strictly controlled. When patients with cholelithiasis have severe obstruction, infection with jaundice, toxic shock and liver complications, or bile duct obstruction and infection recur for a long time, and non-surgical treatment is ineffective, surgical treatment can be considered. In addition, some patients have large gallstones and frequent symptoms, or when liver damage is suspected due to repeated infection of bile duct by stones, the treatment principle is to remove the stones as soon as possible and remove the diseased gallbladder.
There are many non-surgical treatments, such as traditional Chinese medicine, acupuncture, oral litholytic drugs, extracorporeal shock wave lithotripsy and so on. Lithotripsy soup composed of Herba Lysimachiae Christinae, Herba Artemisiae Scopariae, Radix et Rhizoma Rhei and auricular acupuncture can stimulate bile secretion and regulate the contraction and contraction of biliary tract, which has achieved the effect of removing stones in some patients, but this method can not make most patients get rid of removing stones. If the amount of stone discharge is large and hard, it is difficult to discharge it. Stones in gallbladder are caused by slender cystic duct. The effect of stone removal is not ideal, so clinicians think that the diameter of bile duct stones is greater than 1.5 cm, and the diameter of gallbladder stones is greater than 0.5 cm, which is generally not suitable for non-surgical treatment.
Many scholars at home and abroad are deeply studying the treatment methods of taking medicine to dissolve stones. Some patients abroad take ursodeoxycholic acid orally to achieve the effect of dissolving cholesterol gallstones. So this medicine was once famous. However, from the clinical observation of its effect, it takes a long time, has obvious side effects, diarrhea, impaired liver function and other adverse reactions, and the effective rate of clinical treatment is only about 20%. Therefore, there is still a lack of ideal drugs to dissolve gallstones.