胆囊结石病理生理进展分期和个性化诊治
Stage on development of pathophysiology of gallbladder stone and personalized diagnosis and treatment
Received date: 2022-05-10
Online published: 2023-06-06
胆囊结石（gallbladder stone, GS）是常见病、多发病。病人早期多无明显症状，发生梗阻会引起急性胆囊炎。GS继发梗阻性胆管炎、胆源性胰腺炎和胆囊癌等后果严重。世界各地专业组织发布过多个指南和共识，促进了GS的规范诊治，但仍存在许多争议问题。当前临床缺乏大样本全病程的相关研究，忽视GS的预防和早诊早治，造成个性化诊治不足。为了更好地开展预防、选择诊治方法、判断预后和随访，笔者根据疾病发生、发展和转归的病理生理学特点，将GS病程发展分为4期。①成石期；②无症状无梗阻期；③炎症感染期，包括梗阻炎症、化脓坏疽和穿孔脓肿3个阶段；④继发病变期，包括胆囊形态及功能异常阶段、结石移位阶段、继发胆囊癌阶段。依据病理生理的分期，有利于在规范基础上的个性化诊治，使病人获益更多。
郑亚民, 顾利国, 许臣 . 胆囊结石病理生理进展分期和个性化诊治[J]. 外科理论与实践, 2023 , 28(02) : 94 -99 . DOI: 10.16139/j.1007-9610.2023.02.02
Gallbladder stone (GS) is a common disease. There are no obvious symptoms at early stage for the patient with GS. Obstruction will cause acute cholecystitis. Secondary obstructive cholangitis of GS, biliary pancreatitis, gallbladder cancer due to GS would be serious. Many guidelines and consensuses have been published in the world and from many professional organizations, promoting the normative diagnosis and treatment of GS. However, there are still a lot of controversial issues. Currenly, there is a lack of study on the whole course of GS with large samples. Prevention and early diagnosis with treatment of GS are neglected. It results in insufficient personalized diagnosis and treatment. In order to have the prevention, diagnosis, treatment, prognosis and follow-up which are carried out better, the authors divided the course of GS into four stages according to the pathophysiological characteristics of the occurrence, development and outcome of GS. There are: ①stage of stone forming; ②asymptomatic period without obstruction; ③inflammation and infection stage, inclu-ding obstructive inflammation, pyogenic gangrene, perforation abscess; ④stage of secondary lesions, including abnormal gallbladder morphology and function, GS shift, gallbladder carcinoma. According to the pathophysiological staging, it is beneficial to the personalized diagnosis and treatment based on the standard management for the patients who can benefit more.
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