胆囊息肉样病变113例临床病理分析

目的 探讨胆囊息肉病变（PLG）的临床和病理的关系,指导临床诊治。方法 对113例胆囊息肉样病变据其临床和病理诊断的关系进行回顾性分析。结果 113例PLG占同期胆囊切除数据的9.9%,非肿瘤性息肉105例（92.9%）,肿瘤性息肉8例（7.1%）,肿瘤性息肉多为直径＞10mm、单发病灶。8例胆囊腺瘤中有3例癌变。结论 ①胆囊腺瘤癌变倾向明显。②单发且＞10mm的病变宜手术切除。③年龄作为肿瘤危除的参考因素。④对症状不重,没有癌变危险者可定期随访。     

397例胆囊息肉样病变超声的诊断价值及随访结果

目的评估超声检查发现的胆囊息肉样病变(polypoid lesions of the gallbladder,PLG)的病理类型和自然病程,为合理处理PLG提供临床依据。方法回顾分析我院1996～2008年397例超声检查发现的PLG的临床资料(不包括可疑胆囊癌患者),分析接受胆囊切除术患者病变的病理类型,随访患者息肉大小和数量的变化。结果随访120例,中位时间21个月(3～81个月),7例息肉继续增长(息肉直径增大3～6mm,平均3.5mm),103例息肉无变化,10例息肉变小或消失。80例接受胆囊切除者中,26例(32.5%)未见明确息肉(正常胆囊9例,慢性胆囊炎8例,胆石病9例);46例(57.5%)为非肿瘤性息肉(胆固醇性息肉33例,炎性息肉3例,腺肌瘤样增生10例);腺瘤8例(10.0%),其中1例息肉直径14mm手术标本中发现原位癌。1例原位癌随访1年,无肿瘤复发及转移。结论超声检查发现的病变直径≤10mm的PLG很少有伴随症状,无癌变患者可继续观察。     

胆囊息肉样病变338例临床病理分析

目的:探讨胆囊息肉样病变（PLG）的临床和病理的关系,及脂导临床诊治的价值。方法:对338例手术切除的PLG的临床、影像学、病理学的资料进行统计分析。结果:338例PLG占同期胆囊切除数的10．5％,非肿瘤性息肉为311例（92％）;肿瘤性息肉为27例（8％）,肿瘤性息肉倾向于大于10mm并多为单发病灶。5例胆囊癌中有3例为腺瘤癌变者。结论:胆囊腺瘤有癌变倾向;凡单发大于10mm的病变宜手术切除;年龄可作为肿瘤危险指标之一;应重视中青年PLG的定期随访。     

胆囊息肉样病变：附297例报告

目的探讨胆囊息肉样病变（PLG）的临床病理特征及手术指征。方法对手术切除和病理诊断的胆囊息肉样病变297例的临床资料进行回顾性分析。结果 非肿瘤性息肉中80.1%的直径小于10mm，71.6%的表现为多发；而肿瘤性息肉倾向于单发，且直径多大于10mm。结论 胆囊息肉样病变有下列情况时应考虑手术治疗：(1) 肿瘤性息肉；(2) 年龄大于50岁，病灶直径大于10mm，病灶位于胆囊颈部，或伴有胆囊结石者；(3)伴有症状或继发结石者；(4) 经追踪观察，病灶增大。但对非肿瘤性息肉，尤其胆固醇性息肉，手术治疗应持慎重态度。     

胆囊息肉样病变267例临床分析

目的 探讨胆囊息肉样病变(PLG)的临床特点、病理特征及手术指征.方法 回顾性分析经手术切除和病理证实的267例PLG的临床资料.结果 PLG好发于中青年,267例中,女101例,男166例.其中,胆固醇性息肉(CPs)241例(90.3%)为最常见的PLG,临床上无特异性症状.结论 PLG中CPs占绝大多数;单发、年龄＞60岁、直径＞10 mm或合并结石的PLG,应行外科手术治疗;直径＜10 mm无症状者可定期B超随访.PLG行胆囊切除术应有严格的指征.     

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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.     

246例胆囊息肉样病变的流行病学分析

目的 了解胆囊自肉样病变（PLG）的发病情况,病理与临床间的关系。方法 回顾性分析了1989-1998年期间连续246例手术切除的PLG临床及病理学资料。结果 246例PLG占同期胆囊工除术的10.9%。非肿瘤性息肉占87.4%（215/246）。肿瘤性息肉占12.6%（31/246）,肿瘤性息肉倾向于大于10mm,单发,广基,年龄大于50岁及合并有胆囊结石者。结论 胆囊肿瘤性息肉样病变有恶变倾向,主单发,直径大于10mm,广基的病变应手术治疗。特别是年龄大于50岁及合并有胆囊结石者。应重视PLG的定期随访。     

胆囊息肉样病变的病理分类与超声检查特点

目的分析胆囊息肉样病变（PLG）不同病理学类型的超声改变特点,探讨恶性病变的危险因素。方法回顾性分析由超声诊断并经手术和病理组织学证实的84例PLG直径≥10mm的临床资料。根据组织病理学结果将PLG分为良性组和恶性组,分析PLG病理学分类的超声诊断,评估胆囊恶性病变的危险因素。结果84例PLG超声诊断敏感性98．81％,特异性89．29％,准确性94．05％,阳性预测值为88．10％,阴性预测值89．29％,误诊率为10．71％（9／84）。恶性组（44例）与良性组（40例）在年龄（67．5岁US．45．5岁）、合并胆囊结石（27．27％VS．12．50％）、PLG单发（97．14％＇US．75．00％）、直径（35．2mm％15．6mm）、基底部宽（97．73％vs67．50％）、彩色多普勒血流成像（CDFU呈高阻低速型动脉血流频谱（84．00％vs．23．08％）、阻力指数（RI）（≥0．60vs.≤0．35）等指标比较差异有统计学意义（P〈0．05）。结论PLG直径≥10mm超声诊断与手术及病理学分类的符合率较高,对其良恶性的鉴别具有较高的临床价值。年龄≥60岁、PLG单发、基底部宽、直径≥20mm、CDFI高阻低速型动脉血流频谱、RI≥0．60及合并胆囊结石是胆囊恶性病变的危险因素,其中PLG直径是独立的高危因素。超声可作为鉴别和评估胆囊良恶性病变的重要方法之一。     

胆囊息肉297例临床分析

目的 探讨胆囊息肉的病理特征,超声检查在胆囊息肉诊断中的应用价值。方法 对2005年1月至2010年12月我院普外科收治的胆囊息肉行腹腔镜胆囊切除患者297例做回顾性分析。结果 LC术中见297例皆存在胆囊息肉。术后病理：腺瘤型息肉73例（24.6%）;其他类型息肉共224例（75.4%）,其中胆固醇性息肉163例、炎性息肉22例、胆囊腺肌症39例。腺瘤型息肉为单发（87.7%）,其他类型息肉为多发（59.8%）,差异有统计学意义（x2=49.7,P＜0.001）;腺瘤型息肉超声（61.64%）可见血运,其他类型息肉超声（70.1%）未见血运,差异有统计学意义（x2=23.6,P＜0.001）。297例中,超声诊断胆囊息肉直径≥20 mm者30例,术中检查符合率96.66%（29/30）;超声诊断直径10～20 mm者249例,术中检查符合率97.6%（243/249）,超声诊直径＜10 mm者18例,术中检查符合率77.8%（14/18）。结论 腺瘤型息肉多为单发,且超声多可见血运,考虑其癌变风险对比术中及术后出现的并发症应选择手术切除胆囊;超声检查从价格及对比CT等含放射线检查对患者身体造成的损害,可作为目前临床诊断胆囊息肉的首选方法,也是最佳方法。     

《美国超声放射医师学会胆囊息肉管理共识（2022）》解读

2021年美国超声放射医师学会召集胆囊研究领域的多学科专家（放射科、外科、病理科、胃肠病学、超声科等），基于循证医学证据，根据胆囊息肉的形态学特征将胆囊息肉分为“极低风险”、“低风险”与“不确定风险”3个类别，“极低风险”表现为球-壁相连或有细蒂，“低风险”表现为宽蒂、宽基底或无蒂，“不确定风险”类别为息肉连接处胆囊壁处局灶增厚（≥4 mm）。《美国超声放射医师学会胆囊息肉管理共识（2022）》综合息肉生长速度与最大直径提出了胆囊息肉的管理建议，“极低风险”及“低风险”类别息肉直径＞15 mm为手术阈值，“不确定风险”类别直径＞7 mm为手术阈值，另外息肉1年内直径增大4 mm及以上亦为手术指征；＜9 mm的“极低风险”或＜6 mm的“低风险”类别息肉无须随访；其余情况建议对息肉进行3年随访。     

Risk factors to discriminate neoplastic polypoid lesions of gallbladder: A large-scale case-series study

BackgroundPolypoid lesion of gallbladder (PLG) size larger than 10 mm is considered to be one of the surgical indications, but the final pathological results are mostly non-neoplastic polyps. The aim of the study was to define the risk factors to discriminate neoplastic PLG and create more precise criteria for surgical indications.MethodsA large scale, case-series study based on 2704 patients who underwent cholecystectomy for PLG was designed. Logistic regression analysis and receiver operating characteristic curve (ROC) was adopted to identify risk factors and the optimal size criteria for predicting neoplastic PLG.ResultsPatients in the neoplastic group were significantly older than those in the non-neoplastic group and the average PLG size is much larger in the neoplastic group (18.5 ± 4.7 mm vs 12.6 ± 3.6 mm). Neoplastic PLGs are prone to be single and non-neoplastic polyps are usually multiple. On Multivariate logistic regression analysis, PLG size larger than 15 mm and age older than 43 years were found to be the independent risk factors to discriminate neoplastic PLG （Odds ratio 3.546 and 2.77 respectively）. The ROC curve showed that 12 mm might be the more reasonable PLG size threshold for the surgical suggestion.ConclusionsConsidering its moderate diagnostic accuracy, the size of gallbladder polyp larger than 10 mm is insufficient to indicate surgical therapy for PLG and 12 mm should be the more optimal polyp's size threshold. Patients older than 43 years have a higher risk of having neoplastic polyps.     

胆囊隆起样病变的诊治探讨(附203例报告)

目的探讨胆囊隆起样病变的诊治原则。方法回顾分析203例手术切除胆囊隆起样病变病例的临床、病理特点。其中197例行术前B超检查,203例均行术后病理检查。结果胆囊良性病变共190例（胆固醇息肉128例,单纯腺瘤16例）,98．0％的胆固醇息肉直径小于10mm,半数以上的胆固醇息肉为多发;腺瘤多为单发,平均直径为（6．0±3．4）mm;良性病变患者有症状者87．9％（167／190）。胆囊恶性病变13例（腺癌8例、乳头状腺癌5例）,平均直径为（11．2±3．1）mm,年龄均大于55岁。结论对于B超提示的胆囊隆起样病变,胆固醇性息肉、腺瘤是最常见的良性病变,腺癌是最常见的恶性病变。对于有症状者应行手术治疗,年龄大于60岁、直径大于10mm以及合并结石的单发息肉是恶性病变的危险因素。对于无症状者,应综合分析,再决定是否手术。     

Comparison of Surgically Resected Polypoid Lesions of the Gallbladder to their Pre-operative Ultrasound Characteristics

Background  Polypoid lesions of the gallbladder (PLG) have been a common finding on ultrasound examinations of the abdomen and are more prevalent since our use of equipment incorporating pulse shaping increased bandwidth, and enhanced phase use for image reconstruction began in 1996. Our study correlates the pre-operative ultrasonographic findings of these lesions to the surgically resected specimen with specific regard to identifying neoplastic polyps. Methods  A retrospective review was performed of 130 patients who had a pre-operative ultrasound of the gallbladder and subsequently underwent cholecystectomy between August 1996 and July 2007 at the Mayo Clinic Rochester. Results  Seventy-nine pseudopolyps (cholesterol polyps, inflammatory polyps, and adenomyomas) and 15 neoplastic polyps were identified on histopathologic analysis. However, 36 patients (27%) did not have a PLG upon histopathologic analysis. Thirty-one polyps had suspicious ultrasonographic characteristics for neoplastic changes. Twenty-nine were ≥10 mm, 12 had vascularity, and one demonstrated invasion. Of these, there were 23 pseudopolyps and six true polyps with neoplastic changes on final pathology (four dysplastic adenomas and two adenocarcinomas). Three asymptomatic polyps ≤10 mm (4%) in maximum diameter based on pre-operative ultrasound imaging (US) had neoplastic changes at pathology (two dysplastic adenomas and one adenocarcinoma). Several statistically significant risk factors were identified that increased the likelihood for malignancy in a PLG: history of primary sclerosing cholangitis (PSC), local invasion, vascularity, and ≥6 mm maximum diameter based on pre-operative US. Of PLGs ≤10 mm, 7.4% were neoplastic. Twenty-five patients were followed up with at least two serial ultrasound examinations. Of these, seven demonstrated polyp growth. None of these specimens demonstrated neoplastic changes. The positive predictive value (PPV) and negative predictive value (NPV) for ultrasound diagnosing neoplastic changes based on current criteria was 28.5% and 93.1%, respectively, with a false negative rate of 5.0%. Expanding the criteria to include cholecystectomy for PLGs ≥ 6 mm changes the positive predictive value and negative predictive value to 18.5% and 100%, respectively, with a false negative rate of 0%. Conclusion  Histopathologic analysis of polypoid lesions of the gallbladder continues to be the gold standard to identify malignancy. Ultrasound has been used extensively in the pre-operative management of these lesions, but modern ultrasound techniques are unable to differentiate between benign and malignant PLGs with any certainty. We recommend that strong consideration be given to surgical resection of PLGs ≥ 6 mm based on pre-operative US due to the significant risk of neoplasm. Additionally, PLGs in all patients with PSC, any patient in whom diligent long-term follow-up cannot be completed, and lesions that demonstrate growth, vascularity, invasion, or are symptomatic require cholecystectomy. Presented at SSAT at the DDW