治療還是觀察？關於膽囊石頭的手術時機和建議-內科

GB STONES---OPERATION OR NOT？

history of GB stones for 10 years
Occasional right upper abdominal pain after meal for 2 years
one episode of fever and vomitting during attack 2 weeks ago
spontaneously subsided after supportive treatment at your hosp.
no diabetes,no hypertension,no history of operation
recent echo showed several small stones in GB

Was it necessary to receive opeation?
When is the appropiate time for operation?
Any good surgeon you suggested in your hosp,?

Thanks

FRED，60~69歲男性，詢問日期：2002/11/25

蕭永薰醫師回覆-內科

醫事人員經歷：衛生福利部基隆醫院家庭醫學科主任

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

回覆日期：2002/11/25
資料來源：台灣e院 - GB STONES---OPERATION OR NOT

彙整補充說明

針對您的問題，膽囊結石的治療方式確實需要根據個人的病史、症狀及影像學檢查結果來做出判斷。
根據您提供的資訊，您已經有十年的膽結石病史，並且在過去兩年中偶爾出現右上腹痛，最近還有一次發作伴隨發燒和嘔吐，雖然經過支持性治療後症狀緩解，但這些情況都顯示出您的膽囊結石可能已經開始影響到您的生活品質。

首先，根據醫學文獻，無症狀的膽結石患者每年發展成有症狀的風險約為1%至2%。
然而，您已經出現了多次症狀，包括腹痛和最近的發作，這些都可能是膽囊炎或其他併發症的前兆。
根據目前的醫學指導，對於有症狀的膽結石患者，通常建議進行膽囊切除手術，尤其是當症狀影響到日常生活時。

在考慮手術的時機上，若您經常出現腹痛或其他相關症狀，建議儘早進行手術，以避免未來可能出現的嚴重併發症，如膽囊炎、胰臟炎或膽管結石等。
這些併發症不僅會增加手術的難度，還可能對您的健康造成更大的威脅。

至於手術的方式，目前腹腔鏡膽囊切除是最常見且有效的手術方法，因為它的創傷較小、恢復較快，且住院時間通常較短。
當然，手術的選擇也需要根據您的具體情況來決定，包括結石的大小、數量及膽囊的狀況等。

至於醫師的推薦，您可以考慮在您所在的醫院尋找專門從事膽囊手術的外科醫師。
根據之前的建議，您可以諮詢如吳維平醫師或吳澤誠醫師等專家，他們在膽囊疾病的診治上有豐富的經驗，可以為您提供專業的意見和建議。

最後，建議您儘快與您的主治醫師進行詳細的討論，評估手術的必要性及時機，並根據醫師的建議做出最適合您的決定。
健康是最重要的，及早處理可以避免未來更大的健康風險。
希望您能早日康復！

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