Disputes and thinking on the clinical diagnosis and treatment of asymptomatic gallstones / 国际外科学杂志

Cholecystolithiasis is a common clinical disease, which can be secondary to cholecystitis, cholangitis, pancreatitis and gallbladder cancer. Many patients with gallstone have no obvious clinical symptoms such as biliary colic. Some patients are indeed asymptomatic because there are not obstruction and inflammation. However, some patients have no symptoms due to ignorance, mistaken for stomach pain, enteritis, etc. Some patients have no symptoms because of insensitivity and insufficient perception. For other patients with abnormal gallbladder morphology and structure, non-functional gallbladder must be no pain. To clarify the concept, diagnosis and classification of asymptomatic gallstones according to pathophysiological stages is conducive to the development of personalized management strategies. According to guidelines formulated by different periods, different regions and different medical institutions, there are many controversies regarding the management of asymptomatic gallstones, including regular follow-up, drug treatment, surgical resection or gallblades-saving lithotomy. Reasonable personalized diagnosis and treatment requires more in-depth basic research evidence.

Analysis on influence factors of asymptomatic cholecystolithiasis prognosis / 局解手术学杂志

Objective To study the prognosis of patients with asymptomatic gallstones and explore prognostic factors.Methods The clinical data of 227 patients with asymptomatic gallstones in the First Affiliated Hospital of Shihezi University from December 2013 to March 2016 were collected.All patients were followed with questionnaire,finally 192 cases were had been enrolled,of which 57 cases with clinical symptoms were symptom group and 135 cases with no clinical symptons were asymptomatic group.The prognostic factors were analyzed by un-ivariate and multivariate logistic regression.Results Univariate analysis showed that there were statistically significant difference in the num-ber of stones,stone size,diabetes,high fat diet and body mass index between the two groups(P <0.05).The Logistic regression analysis showed that multiple stones,stone diameter ≥1 cm,diabetes were the major risk factors for prognosis in asymptomatic gallstones.Conclusion Multiple gallbladder stones,stone diameter ≥1 cm,diabetes,high fat diet and obesity may be the major prognostic factors for patients with a-symptomatic gallstones.

Asymptomatic gall stones – revisited.

India has a large burden of individuals harboring asymptomatic gallstones. Based on Markov model decision and cost analysis, selective and concomitant cholecystectomy is recommended for special indications like hemolytic disorders and stones in endemic areas. Expectant management should be adopted in all others. The evolution of laparoscopy should not alter the indications of cholecystectomy. Since more than 90% patients with asymptomatic gallstones remain clinically “silent”, routine laparoscopic cholecystectomy is not indicated for the vast majority of subjects with asymptomatic cholelithiasis. Although laparoscopic cholecystectomy has become much safer, there remains associated morbidity and mortality. The risks of the operation outweigh the complications if stones are left in-situ. Patients should be counseled about the natural history and available management options, their advantages and disadvantages, and should be part of the decision making process. Prophylactic routine cholecystectomy for asymptomatic stones is not recommended. However, laparoscopic cholecystectomy should be performed selectively or concomitantly in a specific subgroup of patients.