无症状胆囊结石临床诊治的争议与思考

Disputes and thinking on the clinical diagnosis and treatment of asymptomatic gallstones

胆囊结石是临床常见病、多发病,可继发胆囊炎、胆管炎、胰腺炎和胆囊癌。很多胆囊结石患者没有胆绞痛等明显临床症状。有些患者的胆囊结石没有发生梗阻、胆囊没有伴发炎症,确实处于无症状时期。但有些患者没有症状源于不自知,误认为胃痛、肠炎等;或源于痛觉不敏感或疾病干扰等,对胆囊结石症状感知不足;另有些患者胆囊形态结构异常,胆囊无功能,没有引起痉挛疼痛表现。明确无症状胆囊结石的概念、诊断和依据病理生理分期分类,有利于制定个性化处理策略。不同时期、不同地区和不同专业医疗机构制定的指南共识,对于无症状胆囊结石的处理存在很多争议,包括定期随访、药物治疗、手术切除或保胆取石等,合理的个性化诊疗需要更加深入的基础研究证据。

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.