Minimally invasive gallbladder-preserving lithotomy is the best treatment method in western medicine at present. This operation can save the gallbladder, but most patients may not be doctors, and they don't know that there are many kinds of gallstones: cholesterol gallstones, sediment gallstones, pigment gallstones and mixed gallstones.
Most stones are soft stones, which are not as hard as those in kidney calculi. There are also some stones, such as sediment-like gallstones, with fine particles. The general method of gallbladder-preserving stone removal can not completely clean the stones. Later, with the growth of living habits and time, stones recurred.
The main mechanism of gallstone formation in litholytic therapy (oral cholic acid and other drugs) is the change of bile physical and chemical composition, the decrease of bile acid pool and the increase of cholesterol concentration. It was found that after oral administration of chenodeoxycholic acid, the bile acid pool can enlarge the secretion of cholesterol by the liver, make the cholesterol in the gallbladder become unsaturated, and the cholesterol stones in the gallbladder may dissolve and disappear 19. In 72, chenodeoxycholic acid was first used by Dan Jinger to successfully dissolve and disappear cholesterol gallstones in 4 cases. However, the drug has certain toxic reactions to the liver, such as the increase of alanine aminotransferase, and can stimulate the colon to cause diarrhea.
ESWL1984 Lauerbwch was the first to treat cholelithiasis (ESWL) with ESWL. The commonly used shock wave lithotriptor is EDAP LT-0 1, which consists of 320 piezoelectric crystals embedded in a parabolic disk and emits shock waves synchronously, forming a gathering area with a width of 4mm and a length of 75 mm, and the sound pressure is 9× 107PZ, and 1 is generally adopted. 25~2。 The impact frequency of 5 times per second is 65,438+0,000%, and the therapeutic power lasts for 60 ~ 75 minutes. In addition, B-mode ultrasound real-time imaging is used to locate stones and monitor the lithotripsy process.
4. Oral cholecystography was performed before gallbladder-preserving lithotomy to confirm gallbladder function. General anesthesia, epidural anesthesia and local anesthesia can be used for anesthesia. The incision is located below the right costal margin, and the gallbladder projection is about 2cm long, cutting to the abdomen; Observe the adhesion of gallbladder mucosa and its surroundings in abdominal cavity, and poke a small mouth about 1cm at the bottom of gallbladder to suck out all bile; Observe gallbladder mucosa with choledochoscope and take out stones; According to the situation of gallbladder, we decide whether to expand the cystic duct, and adopt the original "shell plastic surgery" method to change the position of gallbladder and bile drainage to prevent the recurrence of stones caused by cholestasis. Finally, the gallbladder incision and abdominal incision were sutured, and the operation was completed. After operation, magnetic levitation instrument was used for local physical therapy, and pulsating magnetic field was used to prevent the deposition of charged and iron-containing bile mud and prevent bile from flowing to form stones. According to the condition, drugs such as lowering blood lipid and cholesterol or ursodeoxycholic acid are taken when necessary to change the bile composition after operation and prevent the formation of gallstones.