胆囊息肉样病变的手术指征

胆囊息肉样病变的手术指征姚育修（江西医学院一附院南昌３３０００６）胆囊息肉样病变又称胆囊隆起性病变，是影像学诊断术语，指胆囊壁向腔内呈息肉状突起的一类病变的总称。实际上包括胆囊结石以外的所有胆囊疾病。胆囊息肉样病变多在Ｂ超检查时发现，常难于肯定病变性...     

放宽胆囊息肉样病变手术指征的必要性

由于胆囊息肉样病变（ＰＬＧ）术前难于鉴别病变性质，因此手术指征的选择成为外科医生十分关注的焦点，存在着不同的观点。本文分析我院６年来手术治疗８６例ＰＬＧ的临床资料后，主张放宽手术指征十分必要。１临床资料１．１一般资料１９９２年１月至１９９７年１２月６...     

胆囊息肉样病变的诊断与手术指征 (附194例报告)

胆囊息肉样病变(polypoidlesionsofthegall bladder,PLG)又称胆囊隆起性病变,是由胆囊壁向 囊腔内呈局限性隆起的一类病变的总称。我院 1994年1月至2002年9月手术治疗PLG194例, 现报告如下。 临床资料 1.一般资料:1994年1月至2002年9月手术 治疗的194例PLG中,男93例,女101例,年龄25 ～76岁,平均45.7岁。术前均行B超检查,其中 185例诊断为胆囊息肉,9例诊断为胆囊腺瘤。同时 行CT检查42例,6例诊断为胆囊癌。常规体检时 B超发现PLG97例。全组表现为右上腹不适38 例,间断性右上腹疼痛59例。194例均行手术治 疗,占同期胆…     

胆囊息肉样病变的诊断与手术指征探讨

胆囊息肉样病变是指胆囊粘膜局限性隆起性病变的统称临床上常称胆囊息肉。常分为胆固醇息肉、良性非胆固醇息肉和早期胆囊癌 ,包括以下疾病 :胆固醇息肉、纤维瘤、腺瘤、早期胆囊癌等。其中以胆固醇息肉多见 ,约占 80 %。B超检查对胆囊息肉诊断率高 ,并作为胆囊息肉简便而可靠的检查方法 ,具有较高诊断价值。我院近 3年来共诊治 114例胆囊息肉 ,其中 13例开腹行胆囊切除术 ,占 3年胆囊切除总数的 9% ,现报告如下。临床资料自 1998～ 2 0 0 1年 ,我院经 B超检查、手术及病理诊断为胆囊息肉样病 114例 ,男 6 1例 ,女 5 3例 ,年龄 2 1～ 6 5岁…     

严格胆囊息肉样病变的手术指征

目的 探讨胆囊息肉样病变的手术指征,避免无辜胆囊切除.方法 回顾性分析828例B超提示并经手术切除治疗的胆囊息肉样病变临床资料.结果 (1)年龄＞50岁、单发、胆囊息肉直径＞1 cm等是胆囊恶性病变的高危因素;(2)各年度因胆囊息肉样病变而行胆囊切除占同期胆囊切除术的2.7%～7.1%,其中胆固醇息肉占86.11%,胆囊癌占1.92%.结论 目前因胆囊息肉样病变而行胆囊切除术中有绝大部分为非肿瘤性息肉,重视胆囊恶性病变的高危因素、严格胆囊息肉样病变手术指征有其必要性.     

胆囊息肉样病变的诊断与手术指征（附288例报告）

本文分析经Ｂ超和／或病理诊断的胆囊息肉样病变（ＰＬＧ）２８８例，其中肉眼观证实ＰＬＧ２７４例，良性病变２５６例，以胆固醇性息肉占多数，恶性病变１８例。ＰＬＧ的Ｂ超检出率为９２．７％，Ｂ超诊断ＰＬＧ的特异性达９４．８％。作者认为，Ｂ超是诊断ＰＬＧ的简便可靠的检查方法，且具有较高的临床诊断价值。ＰＬＧ的手术指征；（１）直径大于１．０ｃｍ的ＰＬＧ，（２）单发ＰＬＧ，（３）年龄５０岁以上的ＰＬＧ病人，（４     

胆囊胆固醇结晶样息肉手术指征探讨

胆囊胆固醇结晶样息肉手术指征探讨梁久银（武警安徽省总队医院外一科合肥２３００４１）近年来，随着Ｂ超对胆囊息肉样病变（ＰＬＧ）检出率的增加，ＰＬＧ手术指征的掌握在临床显得十分重要。尤其是腹腔镜胆囊切除术（ＬＣ）开展后，对胆固醇结晶样息肉行ＬＣ有增加的趋...     

胆囊息肉临床病理分析及手术指征探讨

目的:分析胆囊息肉样病变的临床与病理资料,探讨胆囊息肉的手术指征。方法:统计分析行手术治疗的2054例患者胆囊息肉临床及病理资料。结果:非肿瘤性息肉占90.1%,年龄≥60岁、直径≥10mm的单发息肉、息肉基底宽或无蒂、合并有胆囊结石者,术后病理检查属恶性者占12.3%。结论:大多数胆囊息肉恶变率极低,年龄≥60岁、直径≥10mm的单发息肉、息肉基底宽或无蒂、近期增长明显增快、息肉合并胆囊炎症状较重或胆囊功能丧失等,是胆囊切除的手术指征。     

胆囊息肉病变的手术适应证

由于B超技术的进步和推广 ,近年来发现胆囊息肉病变(polypoidlesionsofthegallbladder,PLGs)明显增多 ,已成为门诊胆道外科的常见病。对其治疗 ,意见尚有分歧 ,甚至有些混乱。有的医生总是告诫患者 :“赶快切除胆囊 ,否则将发生癌变” ,经常有患者带着恐惧、疑虑来门诊咨询。果真如此严重 ?答案应该是否定的。现对上述问题谈谈个人对本病的认识。1　PLGs的实质及恶变倾向性PLGs是胆囊粘膜凸起性病变的总称 ,它包含着不同的病变 ,临床医生多采纳实用的分类系统 ,将病变分为两大类 :①真性肿瘤 ,主要是来自上皮的腺瘤或腺癌 ,还有罕见的来…     

Diagnosis and operative indications for polypoid lesions of the gallbladder

In 411 patients undergoing cholecystectomy, benign polyps were present in 32 gallbladders and malignant polyps were present in eight. Histologically, cholesterol polyps accounted for most of the benign lesions, and all the malignant lesions were adenocarcinomas. Gallstones coexisted in 50% of the malignant lesions and endoscopic retrograde cholangiography revealed anomalous pancreaticobiliary junctions in three of five patients with malignant lesions. Sixty-nine percent of patients with benign lesions were under 60 years of age, whereas 75% of those with malignant lesions were over 60. Ninety-four percent of the benign lesions were under 1.0 cm in diameter, while 88% of the malignant lesions exceeded this size. Spread and size of the tumor showed a close correlation. Therefore, size of the tumor is a vital indicator in the treatment of polypoid lesions of the gallbladder, and a malignancy should be considered when the tumor exceeds 1.0 cm in diameter.     

胆囊息肉样病变的处理

目的 讨论胆囊息肉样病变(GPL)的诊断和处理.方法 回顾性分析2002年至2011年10年间经超声检查处理的GPL病例.结果 使用腹部超声检查方法确认GPL共591例,其中349例为女性,占59.1％;年龄范围20～73岁.有395例出现腹痛等症状,39.9％是单发息肉,9.8％同存胆囊结石.使用超声检查GPL的特异性为92.5％.136例使用腹腔镜胆囊切除术,对涉及胆囊癌的病例拟施行开腹胆囊扫除术.结论 多数小的GPL为良性,可静止多年.但具有年龄＞50岁,息肉直径＞10 mm的这两条主要危险因素的患者,应预测可能为恶变的GPL.其余恶变的危险因素尚有同存胆囊结石、单发性息肉、有临床症状的息肉等.     

Surgical management of polypoid lesions of the gallbladder

BACKGROUND: With improvements in ultrasonography more polypoid lesions of the gallbladder (PLGs) are being detected. The management of these is controversial. METHODS: The demographic, radiological and pathological data of 38 patients with ultrasonographically detected PLGs were reviewed. A Medline search for such lesions was performed and a review of the literature is presented. RESULTS: Thirty-four patients underwent cholecystectomy and four were advised against or declined operation. Of the 34 who had cholecystectomy, 11 had macroscopic and histopathologically proven PLGs. Of these, seven had cholesterol polyps, two had adenomas, one had a carcinoid tumour and one had an adenocarcinoma of the gallbladder. One patient had a histopathologically normal gallbladder. The remainder had chronic cholecystitis with or without gallstones. All of the patients with neoplastic lesions of the gallbladder had solitary polyps greater than 1.0 cm in diameter. CONCLUSION: A protocol for the management of ultrasonographically detected PLGs is proposed. In this protocol it is suggested that patients with a PLG should undergo surgery if they are symptomatic, or if the PLG is 1.0 cm or more in diameter.     

Image diagnosis of polypoid lesions of the gallbladder

Between 1980 and 1990, 120 cases of polypoid lesions of the gallbladder (GBPL), confirmed surgically and pathologically, were evaluated comprehensively with each kind of image examinations. 110 cases of B-US data were dealt with multiple stepwise regression analysis, and three carcinoma risk factors (size & location of the lesion, age of the patient) were found. The results of Mahalanobis' discriminant analysis showed that the conformity rates of retrospective test (80 cases) and prospective test (30 cases) were 94% and 90%, respectively. In addition, we put forward our own clinical classification of GBPL according to the surgical and pathological data and the need of clinical practice.     

胆囊息肉样病变的超声诊断现状及其新技术应用进展

胆囊息肉样病变(PLG)是指胆囊壁向腔内呈息肉状生长的非结石性病变的总称,其中以胆囊癌的恶性程度高,预后差。因此,早期诊断胆囊息肉样病变的良恶性具有重要的临床意义。超声作为胆囊息肉样病变的首选影像学检查方法,对指导临床治疗具有重要的作用。本文针对胆囊息肉样病变的声像图表现及相关新技术进展进行综述。     

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目的探讨胆囊息肉样病变(PLG)的诊断及手术指征.方法对B超和(或)病理诊断的胆囊息肉样病变109例进行了回顾性分析.结果胆固醇性息肉、腺瘤平均直径分别为(3.69±2.26)mm、(8.0±3.31)mm;97.7%的胆固醇性息肉直径<10mm;肿瘤性息肉(腺瘤)倾向于单发(腺瘤n=1.57±0.9),而超过50%的胆固醇性息肉表现为多发(n=3.89±3.91);1例腺瘤伴有粘膜上皮的不典型增生.结论①B超是诊断PLG的最有效方法.②单发、年龄>50岁、直径>10mm,或合并胆石的PLG应行外科手术治疗.③有明显临床症状者,须首先经过正规的内科治疗,无效且症状影响工作、生活者可考虑手术治疗.④内科治疗后症状缓解或无临床症状者,可通过B超进行定期观察(3～6个月),发现病变有增大趋势者可采取外科治疗.     

胆囊息肉样病变281例临床分析

目的　探讨胆囊息肉样病变的临床若干问题 ,分析其诊疗方法的变化。方法　回顾性分析经手术切除和病理检查证实的胆囊息肉样病变 (PLG) 2 81例的临床资料。结果　 2 81例中 ,男性176例 ,女性 10 5例。其中 ,胆囊胆固醇性息肉 (CPs) 2 5 1例 (89.3% ) ,男性 16 4例 ,女性 87例 ,其症状以腹痛最常见 (79.3% )。结论　PLG中CPs占绝大多数 ;PLG及CPs均为男性多于女性 ;年度手术统计表显示手术例数由少到多再由多到少的改变 ,反映了外科医生对CPs认识的改变 ;因PLG行胆囊切除术应有正确的指征。     

健康体检中胆囊息肉样病变的超声诊断分析

目的 探讨健康体检中超声诊断胆囊息内样病变( PLG)的应用价值.方法 回顾性分析11 816例健康体检者PLG的发生率及其超声声像图特征.结果 在11 816名健康体检者中,共发现PLG 495例;男332例,发生率为4 6％;女163例,发生率为3.5％,男性发生率显著高于女性(P<0.05).在本次体检人群中,以41~50岁年龄组PLG发生率最高,男性为7.8％,女性为6.3％.495例PLG的二维超声声像图特征如下:①59.2％( 293/495) PLG有蒂或基底较窄:②80.4％病灶呈强回声或中等回声;③91.9％( 455/495)病灶见于底、体部;单发PLG为182例,占36.8％,多发者313例(63.2％);④PLG体积大多数较小,平均(6.1±3.9) mm;⑤10.7％( 53/495) PLG合并有胆囊结石.结论 胆囊超声普查有利于早期发现PLG,为及时治疗提供依据.     

Polypoid lesions of the gallbladder: indications for surgical treatment

Through the study of a population of 176 patients with polypoid lesions of the gallbladder, our aim was to demonstrate the advantages of ultrasonography in the identification of those cases in which surgical intervention is indicated. From among our patients, specific criteria were used to select 92 patients to submit to cholecystectomy. These criteria were based on a thorough evaluation of the clinical data (patient's age, familiarity, presence of symptoms), and on careful examination of the ultrasonographic images (number and size of lesions, presence of associated cholelithiasis, state of the gallbladder wall). The histological results and the literature data confirmed the validity of our protocol. The risk factors for carcinoma are age (> 60 years), coexistence of gallstone disease, and the size of the lesions (> 10 mm). Therefore, when these risk factors are present, cholecystectomy is justified even in asymptomatic patients.