慢性胆囊炎胆囊结石行保留及切除胆囊的争议与共识

胆囊切除术作为慢性胆囊炎胆囊结石的标准治疗模式已沿用百余年。黄志强院士所提出的“除了在紧急情况下实施胆囊造瘘术治疗急性胆囊炎外，胆囊结石的外科治疗是切除含结石的病理胆囊，并适当地处理结石的胆囊外并发症”的治疗原则在胆道外科学界已达成共识。近10余年来，我国出现了对于该病“保胆”与“切胆”之争。国内的保胆取石术尚缺乏规范化的适应证标准和技术操作标准，尤其是有关结石复发问题尚未得以解决，在无大宗病例前瞻性研究报告证实其确切疗效之前，还不宜作为标准术式广泛推广开展。建议仅在临床症状轻微、胆囊功能良好、无代谢综合征和家族史、且个人意愿强烈病人和急症条件下的老年、高危病人中试行。应进一步加强相关的临床与基础研究，完善对慢性胆囊炎胆囊结石病手术治疗的技术管理。

Controversy and Consensus of reserve or removal gall bladder for Chronic Cholecystitis and Gallstone

Controversy and Consensus of reserve or removal gall bladder for Chronic Cholecystitis and Gallstone        LU Qi-ping. Department of General Surgery, Wuhan General Hospital of Guangzhou Military Command, Wuhan 430070, China
Abstract    Cholecystectomy has been used for hundreds of years as the standard treatment model of the disease. The therapeutic principle that “Removal the pathology gallbladder with stone with the addition of managing complications outside the gall bladder properly should be the standard treatment, except implement gallbladder fistula operation for acute cholecystitis in case of emergency” performed by academician Huang Zhi-qiang has reached a consensus in biliary tract surgery field. “Cholelithotomy ” or “cholecystectomy ”is the focus of discussion for nearly a decade. There are still no standards for indication and technical operation, especially the problem of postopreation recurrence of stone is not resolve successfully yet, so cholelithotomy should not widely carried out in the absence of large amount of prospective study to confirm the exact curative effect. Which is recommended only on condition of clinical symptoms mild, gall bladder function is well , no family history of metabolic syndrome, elderly in emergency and patients with high-risk. While the former should pay attention to take effective measures to prevent the postoperative recurrence of stones, and ready for cholecystectomy; the latter is only for patients who can’t tolerate emergency cholecystectomy, and elective cholecystectomy should be performed after remission. Relevant clinical and basic researches should move forward under the idea of precise surgery. At the same time, relevant clinical and basic research should be further strengthened, and improve the technology management of surgical treatment for chronic cholecystitis and gallstone disease needs to be improved further.