Moderator: How about gallstones?
Ren Xu: Cholelithiasis occurs in the biliary system, including gallbladder stones and bile duct stones, and bile duct stones include intrahepatic bile duct stones and extrahepatic bile duct stones. Cholelithiasis is a common disease. In the United States, 1 10,000 people get sick every year. The incidence rate in China is not clear, but it is still high in clinic, and the incidence rate of women is higher than that of men. Common bile duct stones mostly occur in the elderly, especially those over 50 years old.
Moderator: What are the symptoms after suffering from gallstones?
Ren Xu: The clinical symptoms of gallstones vary from site to site. The symptoms of gallstones in the gallbladder are pain in the right upper abdomen and fever after infection. Suppurative cholecystitis can lead to perforation of gallbladder. With the recurrence of diseases, the function of gallbladder will be lost, leading to gallbladder atrophy, which will affect the digestion of food. But there are also13 patients who have no symptoms and do not need treatment. Bile duct stones can appear obstructive jaundice, fever, chills, high fever, biliary colic and other symptoms. If the stone is at the end of the common bile duct, it will cause acute pancreatitis; If bile is infected, it will cause acute obstructive suppurative cholangitis; If stones in bile duct have intermittent chills and high fever symptoms, obstructive cholestatic cirrhosis will occur with the extension of the disease; In addition, some patients with intrahepatic bile duct stones will cause cholangiocarcinoma.
Moderator: How to treat gallstones?
Tang Xiufen: Traditional treatments include surgical treatment, laparoscopic cholecystectomy for gallstones, oral litholytic drugs, ultrasonic lithotripsy and other non-surgical methods, but they all have certain indications. Oral litholytic drugs are limited to pure cholesterol gallstones, and there are few patients with pure cholesterol gallstones in China, so it is easy to relapse after litholysis. For example, the elderly or people with cardiopulmonary insufficiency are not suitable for surgical treatment, so at present, the best way is to take stones through endoscope, which can be taken through the mouth, duodenum or skin (abdominal wall). First, cholangiography is needed, small stones can be taken out directly, and large stones can be taken out after lithotripsy. Our hospital has treated more than 0/000 patients/kloc, and the effect is satisfactory.
Ren Xu: If the patient has undergone subtotal gastrectomy, it is not suitable for endoscopic treatment. In addition, if the stone exceeds 3cm, it is necessary to carry out nickel electrolithotripsy.
Moderator: Will taking stones damage the duodenum?
Tang Xiufen: People without coagulation dysfunction can be said to be very safe. Even if there is bleeding, there are hemostasis measures, and the bleeding rate is less than 1%. Local anesthesia can be used before digestive endoscopy, and some sedatives can be used, which is less painful than gastroscopy Stone removal treatment requires short-term hospitalization and some blood tests. The patient can't eat for 24 hours after taking the stone. If there are no symptoms, they can eat after 3 days. Ren Xu: Common bile duct stones are suitable for oral lithotripsy, while gallbladder stones and stones in gallbladder are suitable for percutaneous lithotripsy.
Tang Xiufen: The incision of puncture treatment is 6 mm, and the liver has strong regenerative ability, so the treatment is not very harmful to the body.
Moderator: Will the gravel hurt the bile duct or bile duct?
Tang Xiufen: As long as the operation is carried out according to the regulations, there is no damage to the biliary tract and bile duct for stones and gravel, and the patient has no pain during local anesthesia treatment.
Moderator: Suffering from gallstones and complicated with acute cholecystitis, can endoscopic treatment be performed?
Ren Xu: Percutaneous puncture can be used for treatment, but if the inflammation is serious and there is suppurative cholecystitis, it is necessary to drain first, and then see if it is suitable for percutaneous lithotomy. If it is not suitable, other treatment methods can be adopted.
Moderator: Zhao Nvshi has been suffering from diabetes and hypertension for many years. He had abdominal pain a month ago. It is found that there are two stones in the gallbladder, the size of which is 2.5cm. Is it suitable for percutaneous endoscopic treatment? What's the effect?
Tang Xiufen: It is recommended to do cholangiography to see the condition of gallbladder and to do gallbladder motor function examination. If they are all suitable for percutaneous endoscopic lithotripsy, stones can be removed after lithotripsy, and the effect is ideal.
Moderator: Mr. Xia of Anhui had hyperthyroidism and pancreatitis before, but now he has gallstones 1.0cm×0.8cm. Can he be treated by the method introduced by experts?
Ren Xu: I don't know whether this is acute pancreatitis or chronic pancreatitis. I suggest going to the hospital for examination. If appropriate, we can do endoscopic lithotomy.
Moderator: Ms. Liu of Kunming suffers from gallstones and rheumatic heart disease. Can I do endoscopic treatment?
Tang Xiufen: If the heart disease is not serious, you can do endoscopic treatment. There is no age limit.
Moderator: Mr. Lu of Guiyang has had several B-ultrasound examinations since last June 1 1. Conclusion There are two polyps, one is calculous polyp of multiple cholecystitis and the other is cholesterol polyp. Can I treat it with an endoscope?
Ren Xu: Endoscopic treatment of polyps is not our topic today, but it can also be treated, but if it is multiple polyps, surgery is needed.
Moderator: Ms. Wang, who just came from Beijing, said that dissolved stones are easy to recur. Is the recurrence rate high after choledochoscope lithotomy?
Tang Xiufen: We have done 200-300 cases, 2 cases have recurred, and the recurrence rate is 1%.
Ren Xu: Endoscopic treatment can also be performed after recurrence. Recurrence is related to gallbladder function, and attention should also be paid to the thoroughness of litholysis.
Moderator: Do you still need to cooperate with Chinese medicine after treatment?
Ren Xu: It can be treated with traditional Chinese medicine, but if the stone component is not cholesterol-type, the effect of taking medicine is not ideal.
Moderator: Ms. Zhao of Jiangsu is pregnant for 7 months. Recently, she was diagnosed with gallstones all over the body. She doesn't have a fever. Need an operation? If surgery is performed, will laparoscopy affect the fetus? Can I take the medicine after delivery?
Tang Xiufen: If there are no symptoms of stones, it is a quiet type of stones, which can be temporarily left untreated. If there are symptoms after delivery, you can first carry out anti-inflammatory treatment, and do not carry out endoscopic treatment for the time being.
Moderator: Suffering from gallbladder and common bile duct stones, how to treat them?
Tang Xiufen: Traditional treatment requires major surgery, which is very traumatic to patients. At present, experts believe that the common bile duct stones can be removed by endoscope first, and then the treatment method can be selected according to the location of gallbladder stones, so that one major operation can be turned into two minor operations and the trauma to patients can be reduced.
Moderator: Ms. Lin from Sichuan was diagnosed with multiple stones in intrahepatic bile duct. The doctor said that there were multiple stones in the left and right hepatic ducts, and the surgical treatment was difficult. Can I treat it with an endoscope?
Ren Xu: We can choose the side with heavier stones to take stones first, for example, from right to left, or we can take stones at the same time with the oral endoscope.
Moderator: Mr. Zhang from Tianjin had a gastrectomy in May this year. Postoperative gastroscopy showed bile reflux and gravel in bile. Can you do endoscopic surgery?
Tang Xiufen: The probability of gallstones after gastrectomy is 10%-20%. I don't know what gastrectomy I'm doing. If it is type 2 surgery, the success rate of endoscopic surgery is low. You can find an experienced doctor to do it. Surgery is recommended.
Moderator: Mr. Henan Tian, what kind of operation method is used for intrahepatic bile duct stones?
Ren Xu: Does this mean that there are stones in the liver and common bile duct? He doesn't know. Stones in the liver are mainly treated by percutaneous endoscopy. If the position is narrow, the stone can be removed after expansion.
Moderator: Mr. Yuan of Lanzhou suffers from chronic cholecystitis, stones in the gallbladder, mild cirrhosis and portal hypertension. Is it suitable for laparoscopic surgery?
Tang Xiufen: The probability of cholelithiasis in patients with liver cirrhosis is 20%, and laparoscopic resection can be performed.
Moderator: Ms. Yang from Zhengzhou, are endoscopic treatment and laparoscopic treatment the same thing? My husband has hepatolithiasis without any symptoms. Need an endoscope?
Ren Xu: It's not the same thing. Laparoscopy needs to open three holes in the abdominal wall, and bile duct stones can also be taken out under laparoscopy. Intrahepatic stones cannot be solved by laparoscopy. Cholangiography is recommended. If it is hepatolithiasis, the patient has no symptoms and does not need treatment.
Moderator: Ms. Chen in Sichuan still has symptoms of gallstones after cholecystectomy. How's it going?
Tang Xiufen: It is recommended to check the bile duct system. If there are stones in the bile duct, they can be removed by endoscope.
Ren Xu: If there are no stones in the bile duct, we can check whether the sphincter of duodenal papilla is spastic by imaging, which usually happens in 8% of patients after operation.
Moderator: Ms. Cai from Jiangxi suffers from gallstones. Is there a family history of this disease? Can super gravel damage the liver?
Ren Xu: There is no genetic history of gallstones. This kind of gallstone is related to diet. There are fewer people suffering from pure cholesterol gallstones in China. Gravel will not damage the liver as long as it is operated in a prescribed way.