治療還是觀察？關於膽囊石頭的手術時機和建議-內科

蕭永薰 醫師回覆-內科

Dear FRED:1.The management of silent gallstones remains controversial.The risk of developing symptoms or complications requiring surgery is quite small,around 1 to 2 percent per year,in most asymptomatic gallsone patients.2.The recommendations for prophylactic cholecystectomy in gallstone patients are probably based onf assessment of several factors as belos,(1)the presence of symptoms that are frequent enough or severe enough to interfere with the patient’s general routine;(2)the pressence of a prior complication of gallstone disease,i.e., history of acute cholecystitis,pancreatitis, gallstone fistula,etc.;or(3)the presence of an underlying condition predisposing the patient to increased risk of gallstone complications(e.g,calcified or poreclain gallbladder,cholesterolosis, adenomyomatosis,and /or a previous attack of acute choleystitis regardless of current symptomatic status).(4)Patients with very large gallstones (over 2 cm in diameter) and patients having gallstones in a congenitally anomalous gallbladder also might be considered for prophylactic cholecystectomy.(5)Although age under 50 years is a worrisome factor in asymptomatic gallstone patients,few authorities would now recommend routine cholecystecotomy in all young patients with silent stones.3.In addition,open cholecystectomy and laparoscopic cholecystectomy are both choices of surgical interventions for gallstone patients.The choice of procedure is dependent upon some considerations.4.At our hospital,(1) Dr.吳維平is excellent physician that he will give you good suggestions about the gallstone disease.(2)Dr.吳澤誠is an expert surgeon that he could afford open cholecystectomy or laparoscopic cholecystectomy by the condition.5.In conclusion,you had better discuss with your doctors in details about the dilemma and make a good decision eventually.Shiau,Yeong-shiun MD,MPH