胆囊|这个被国外指南淘汰十几年的手术，终于被踢出中国专家共识( 四 ) 胆囊|胆囊结石|保胆取石|共识

胆囊癌是一种侵袭性很强的恶性肿瘤，大部分患者一发现就是中晚期，死亡率很高, 五年生存率不足 5%。许多医生和患者往往低估了胆囊癌的凶险。张永杰教授告诉丁香园：「我遇到过最年轻的胆囊癌患者只有 18 岁。」
除了以上的医学讨论，许多医生考虑到医疗责任等法律因素，对于无症状胆结石患者是否手术，仍交给患者自行决定。
孙绳墨医生表示「目前对患者的治疗建议通常遵循第九版《外科学》上建议的手术指征。对于无症状胆囊结石患者，手术指征为『结石数量多或者≥2到3cm，胆囊壁钙化或者瓷性胆囊，胆囊息肉≥1cm，胆囊壁增厚≥3mm 。』建议手术，其余随诊观察。」
「在制定《共识》的讨论中，许多专家深知这一条手术指征一定会引起争议，但仍然坚持将它提出来，希望引起大家警惕，因为这关系到很多患者的生命。」张永杰教授对丁香园表示。基于这个原因，最终并没有将其命名为「指南」而是「共识」，欢迎更多医生关注并加入讨论。（策划：自如、gyouza）
题图来源：图虫创意
参考文献：
1. Wang HH, Afdhal NH, Gendler SJ, Wang DQH. Evidence That Gallbladder Epithelial Mucin Enhances Cholesterol Cholelithogenesis in MUC1 Transgenic Mice. Gastroenterology. 2006;131(1):210-222. doi:10.1053/j.gastro.2006.04.011
2. Farber S, Diamond LK, Mercer RD, Sylvester RF, Wolff JA. Shock-wave lothotripsy of Gallbladder Stones--The first 175 Patients. New Engl Jounal Med. 1988;318:393-397. doi:10.1056/NEJM198603273141302
3. Su CH, Huang SM, Lui WY. Extracorporeal Shock-Wave Lithotripsy of Gallbladder Stones. Vol 91.; 1992.
4. Lievens M, Schutz SM. Percutaneous cholecystolithotomy: is gall stone recurrence inevitable? Gastrointest Endosc. 1995;41(3):271-272.
5. Zou YP，Du JD，Li WM，et al. Gallstone recurrence after successful percutaneous cholecystolithotomy: a 10-year follow-up of 439 cases. Hepatobiliary Pancreat Dis Int. 2007;6(2):199-203.
6. Hortobagyi GN, Connolly JL, Orsi CJD, et al. AJCC Cancer Staging Manual 8th Edition.; 2020. doi:10.32388/b30ldk
7. Lamont JT, Smith BF, Moore JRL. Role of Gallbladder Mucin in Pathophysiology of Gallstones. Hepatology. 1984;4(2 S):51S-56S. doi:10.1002/hep.1840040809
8. 刘昌，孟凡迪，王瑞涛. 胆石症基础研究现状与展望. 中国实用外科杂志. 2021;4(1):48-51.
9. Du S, Zhu L, Sang X, et al. Gallbladder carcinoma post gallbladder-preserving cholecystolithotomy: a case report. Hepatobiliary Surg Nutr. 2012;1(1):61-63. doi:10.3978/j.issn.2304-3881.2012.07.01
10. Palfreyman H, Kneebone RL. Blind alleys and dead ends: Researching innovation in late 20th century surgery. Med Humanit. 2018;44(3):165-171. doi:10.1136/medhum-2016-011176
11. 王向，张永杰. 对保胆取石历史和现状再认知. 中国实用外科杂志. 2021;41(6):662-667.
12. Qu Q, Chen W, Liu X, et al. Role of gallbladder-preserving surgery in the treatment of gallstone diseases in young and middle-aged patients in China: results of a 10-year prospective study. Surg (United States). 2020;167(2):283-289. doi:10.1016/j.surg.2019.09.001
13. Lammert F, Acalovschi M, Ercolani G, et al. EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol. 2016;65(1):146-181. doi:10.1016/j.jhep.2016.03.005
14. Kenlan K. Percutaneous Cholecystolithotomy Preliminary Experience. Radiology. 1985;157:653-656.
【胆囊|这个被国外指南淘汰十几年的手术，终于被踢出中国专家共识】16. LESLIE J. SCHOENFIELD, M.D., Ph.D; JOHN M. LACHIN, Sc.D.; THE STEERING COMMITTEE (RICHARD A. BAUM, M.D.; ROBERT L HABIG, Ph.D.et al. Chenodiol (Chenodeoxycholic Acid) for Dissolution of Gallstones: The National Cooperative Gallstone Study. Ann Intern Med. 1982;97(3):391-398.