1. Cholecystectomy: It is the most accurate and effective method for treating gallstones, and the technology is mature. However, the disadvantage is that the physiological function of the gallbladder is completely lost, and various complications such as bile duct injury, post-cholecystectomy syndrome, and papillary sphincter dysfunction may occur.
2. Cholecystolithotomy: A method of surgically removing gallstones from the gallbladder while preserving the gallbladder. The advantage is that the function of the gallbladder is preserved, but the biggest problem is that the recurrence rate of gallstones is extremely high in the future. Once the gallstones recur, the surgery is in vain!
3. Drug dissolution: If oral drugs can dissolve stones, that would be ideal. Unfortunately, only ursodeoxycholic acid has this effect, and it is limited to 5% to 15% of stone patients (pure cholesterol stones). Studies have shown that even if the stone is successfully dissolved, the recurrence rate in the future is still as high as more than 50%.
4. Extracorporeal shock wave lithotripsy: It was once used as a minimally invasive method in clinical practice. However, it also faces the disadvantages of limited efficacy, high recurrence rate of stones after surgery, and possible liver damage.
Based on the above information, experts in related fields have reached the following consensus on the treatment of gallstones:
1. The treatment of gallstones should be individualized based on factors such as whether the patient has symptoms, whether the gallbladder is functional, whether there is inflammation, whether there are complications, and whether there are conditions for surgery.
2. Patients with asymptomatic or mildly symptomatic gallstones do not need routine preventive cholecystectomy (so-called expectant management).
3. Prophylactic cholecystectomy may be an option for elderly patients in whom expectant management may significantly increase surgical risks.
4. Patients whose symptoms of gallstones significantly affect their work and life or who have had a history of biliary colic, acute cholecystitis, biliary pancreatitis, etc. should undergo elective cholecystectomy.
5. For patients with gallstones who have high risk factors for gallbladder cancer or suspected gallbladder cancer, surgery should be performed regardless of whether they have symptoms.
6. Cholecystectomy is the standard surgical procedure for the treatment of gallstones. If conditions permit, laparoscopic surgery should be the first choice.
7. The practical value of cholecystolithotomy needs further study. Currently, it is only suitable for emergency treatment under acute conditions and is not recommended as an elective surgical procedure.
8. The cure rates of drug lithotripsy, stone removal therapy, and extracorporeal shock wave lithotripsy are low and may lead to serious complications. They are not currently recommended for clinical use.
