1. Lithotripsy (oral cholic acid and other drugs dissolve stones): The main mechanism of gallstone formation is the change of bile physical and chemical composition, the decrease of bile acid pool and the increase of cholesterol concentration. The results showed that after taking chenodeoxycholic acid orally, the bile acid pool could be increased, and the cholesterol secreted by the liver decreased, which made the cholesterol in the gallbladder become unsaturated, and cholesterol stones in the gallbladder might dissolve and disappear. 1972, Dan Jinger used chenodeoxycholic acid for the first time 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.
At present, chenodeoxycholic acid and its derivative ursodeoxycholic acid are the main drugs to treat osteolysis. Indications for treatment: ① The diameter of gallstones is less than 2cm; ② Gallbladder stones are stones that can be penetrated by X-rays and contain little calcium; ③ The cystic duct is unobstructed, that is, functional gallbladder can be displayed on oral cholecystography; ④ The patient's liver function is normal; ⑤ No obvious history of chronic diarrhea. The therapeutic dose is 65438 05 mg/g per day, and the course of treatment is 6 ~ 24 months. The effective rate of stone dissolution is generally 30 ~ 70%. During the treatment,/kloc-0 b-ultrasound or oral cholecystography were performed every six months to understand the dissolution of stones. Because this kind of litholytic therapy is expensive and has certain side effects and toxic reactions, it must be taken for life. For example, after three months of drug withdrawal, cholesterol in bile will be supersaturated again and stones will recur. According to statistics, the recurrence rate can reach 25% within three years. At present, this kind of litholysis therapy still has some limitations. In addition, some new drugs, such as lovastatin and metronidazole, also have certain litholytic effects. The combined application of phenobarbital and chenodeoxycholic acid can often increase the stone dissolving effect. 1985 reported that percutaneous puncture of gallbladder cannula and injection of caprylic monoglyceride or methyl tert-butyl ether directly dissolved gallstones, and achieved certain results.
2. Traditional Chinese medicine promotes stone removal (suitable for patients with fine sand-like stones and poor gallbladder function)
(2) Surgical treatment of gallstones
1. Traditional cholecystectomy
2. Open exploration of bile duct stones.
3. Laparoscopic small incision cholecystectomy
4. Laparoscopy combined with choledochoscopy to explore bile duct and take stones.
5. Small incision gallbladder-preserving lithotomy (suitable for those patients with intact gallbladder function and young age, and it is also a better method to remove stones and protect gallbladder at present. )
Traditional Chinese medicine formula for treating gallstones
Traditional Chinese Medicine Prescription (1)
Syndrome differentiation of damp-heat stagnation of liver and gallbladder invading China.
Treat gallstones, strengthen spleen and relieve pain.
Fangming Biliary Duct Paishi Decoction.
It consists of 9 grams of Bupleurum, 6 grams of Pseudostellaria heterophylla 15 grams, 0/5 grams of Paeonia lactiflora, 30 grams of Desmodium styracifolium, 0/2 grams of Radix Curcumae/kloc-0, 6 grams of Pollen Typhae, 6 grams of Oletum Trogopterori and 3 grams of licorice.
Usage: decoct with water, 1 dose, twice a day.
Originated in Deng Tietao.
Traditional Chinese Medicine Prescription (2)
The connotation of damp heat is differentiated and accumulated into stones for a long time.
Soothing the liver and regulating qi, benefiting gallbladder and removing stones.
Fang Mingdan Paishi Tang.
Consists of 9 grams of prepared rhubarb, 9 grams of immature bitter orange, 0/5g of giant knotweed rhizome/kloc-,0/5g of turmeric root/kloc-,and 30g of lysimachia christinae.
Usage: decoct with water, 1 dose, twice a day.
Originated in Jiang Chunhua.
Traditional Chinese Medicine Prescription (III)
Syndrome of liver depression and qi stagnation.
Soothing the liver, relieving depression, regulating qi and relieving pain.
Fangming Shugan Lidan Decoction.
It consists of Bupleurum10g, Fructus Aurantii Immaturus10g, Pericarpium Citri Reticulatae Viride10g, Pericarpium Citri Reticulatae10g, Polygonum cuspidatum 30g, Flos Lonicerae 30g, Radix et Rhizoma Rhei12g, Herba Lysimachiae Christinae 30g, Herba Artemisiae Scopariae 30g and Radix Curcumae.
Usage: decoct with water, 1 dose, twice a day.
Source Xie Xinjian Fang
Traditional Chinese Medicine Prescription (IV)
Syndrome differentiation liver qi stagnation, wood stagnation into fire.
Soothing the liver and regulating qi, clearing heat and relieving depression, benefiting gallbladder and expelling stones.
Fang mingqing gallbladder fossil soup.
It consists of 6 grams of Bupleurum, 0/5g of centipede/kloc-,6 grams of corydalis yanhusuo, 0/5g of Lysimachia christinae, 0/5g of Jin Lingzi/kloc-,9 grams of Scutellaria baicalensis Georgi, 6 grams of Radix Curcumae, 3 grams of medulla tetrapanacis, 0/2g of dandelion/kloc-and 0/5g of Herba Artemisiae Scopariae.
Usage: decoct with water, 1 dose, twice a day.
The source is Weng Gongfang.
Traditional Chinese Medicine Prescription (5)
Syndrome of damp-heat accumulation in liver and gallbladder.
The treatment methods are soothing the liver and benefiting gallbladder, clearing away heat and promoting diuresis, regulating qi and regulating camp, and relieving pain and resolving hard mass.
Fangming Shugan Lidan Decoction.
It is prepared from Radix Bupleuri 10g, Radix Scutellariae 8g, Spora Lygodii 15g, Herba Lysimachiae Christinae 15g, Endothelium Corneum Gigeriae Galli 10g, Rhizoma Chuanxiong 8g, parched Jin Lingzi 10g, Radix Paeoniae Alba 10g, and parched Fructus Aurantii Immaturus.
Usage: decoct with water, 1 dose, twice a day.
Originated in Li Peisheng.
[Edit this paragraph] What are the clinical characteristics of intrahepatic bile duct stones?
Intrahepatic bile duct stones refer to stones produced by intrahepatic bile duct system, so they are also called intrahepatic bile duct stones. Often coexist with extrahepatic bile duct stones, but there are also simple intrahepatic bile duct stones, also known as true intrahepatic bile duct stones. In recent years, there are more and more cases of intrahepatic bile duct stones. Among 474 cases of cholelithiasis confirmed by surgery reported in China, this kind of stones accounted for 65438 05.4%. Most of them are accompanied by common bile duct stones. The classification of stones mostly belongs to bilirubin stones.
Hepatolithiasis is mostly composed of yellow-green massive or "sediment-like" stones, mostly calcium bilirubin. Ascaris eggs are often seen in the center of stones, so some doctors think that intrahepatic bile duct stones are caused by biliary ascaris and bacterial infection.
Intrahepatic lithiasis is mostly in the left lobe of the liver, and the bile duct at the junction of the upper and lower segments of the left lateral lobe of the liver is slightly thickened, and stones are mostly left there. Right hepatolithiasis is more common in the right posterior lobe of the liver. Clinical features are as follows:
(1) patients are younger than those with gallstones, and some patients are related to congenital anomalies of intrahepatic bile duct. Patients often have a history of recurrent abdominal pain, chills, fever and jaundice since childhood.
(2) Liver function is damaged and gallbladder function may be normal. There are many abnormalities in liver function during recurrent attacks, and alkaline phosphatase increases during intermittent attacks; Long-term illness will lead to liver lobe atrophy and liver fibrosis.
(3) Abdominal pain, jaundice and fever are the main symptoms, but typical severe colic rarely occurs.
(4) There are many and serious complications. Common diseases include suppurative intrahepatic cholangitis, liver abscess and biliary bleeding.
(5) Cholangiography can show intrahepatic bile duct dilatation without extrahepatic bile duct dilatation, and there is a small transparent area in the hepatic duct.
[Edit this paragraph] Dietary therapy for gallstones
The reasons for the formation of gallstones are complicated, but the changes of bile components, especially the changes of bile salts and cholesterol, are important factors for the formation of gallstones. Under normal circumstances, they keep a certain proportion in bile. Cholesterol is dissolved and excreted with bile. If there is too little bile salt or too much cholesterol, the normal proportional relationship between them will be lost, cholesterol will be supersaturated, and too much cholesterol in bile will precipitate to form stones.
If there are inflammation, ascaris eggs, necrotic tissue and bile pigment in the gallbladder at the same time, it is easier to form stones. However, sugar can stimulate islet β cells to secrete insulin, increase cholesterol, lead to supersaturation of cholesterol in bile and promote the formation of gallstones.
The diet of 267 patients with cholelithiasis and 600 healthy people was investigated and analyzed. The results show that the more sugar you eat, the higher the incidence of cholelithiasis.
Therefore, to prevent the occurrence of gallstones, we must reduce blood sugar.
1. Pay attention to food hygiene and avoid parasitic infection.
2. Eat a low-fat diet and eat more fresh vegetables, fruits, edible lean pork, chicken and duck egg whites, etc.
3. Avoid fried food, animal fat and internal organs, and eat egg yolk, fish and crustaceans carefully.
4. Avoid alcohol, tobacco and spicy food.
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 it should be prevented from being excessive, generally 1500 ~ 2400 calories.
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, and it can be slightly increased with the improvement of the condition to improve the color, aroma and taste of the dishes. Avoid greasy, fried, fried and fatty foods, such as fat pork, mutton, stuffed duck, fat goose, butter, cakes and cream cakes.