胆囊息肉样病变的手术指征探讨

目的:探讨胆囊息肉样病变的手术指征.方法:回顾性分析320例胆囊息肉样病变病例的临床资料和病理组织学特点.结果:本组患者中295例为良性,25例为恶性息肉.≥60岁病人胆囊癌的发生率20.73%(17/82)明显高于<60岁患者的3.36%(8/238,P﹤0.05);196例有蒂息肉中2例癌变(1.02%),而124例无蒂息肉中23例癌变(18.55%),无蒂者癌变率明显高于有蒂者(P﹤0.05);123例伴有胆囊结石患者中22例癌变(17.89%),无胆石伴发患者197例中3例癌变(1.52%),前者癌变明显高于后者(P﹤0.05);﹥10 mm的97例息肉中恶性23例(23.71%),而﹤10 mm的223例中仅2例恶性(0.90%),两组比较,差异有显著性(P﹤0.05).结论:对于年龄≥60岁、伴有胆囊结石、无蒂息肉或息肉直径﹥10 mm的胆囊息肉样病变患者均应手术治疗.

Operative Indications of Polypoid Lesions of Gallbladder

Objective :To investigate operative indications for polypoid lesions of gallbladder.Methods: Clinical data were retrospectively correlated with histopathologic characteristics of polypoid lesions in 320 patients who had cholecystectomy.Results: There were 295 benign polypoid lesions and 25 malignant polypoid lesions of gallbladder.The malignant rate of patients with over 60 years old(20.73%-17/82) was significantly higher than that of patients under 60 years old(3.36%-8/238,P<0.05).The malignant rate of patients with pedunculated lesions(1.02%-2/196) was significantly lower than that of patients with sessile lesions(18.55%-23/124,P<0.05).The malignant rate of patients of gallstones coexisted (17.89%-22/123) was significantly higher than that of patients without gallstones coexisted(1.52%-3/197,P<0.05).The malignant rate of patients of polyps large than 10 mm in diameter(23.71%-22/97) was significantly higher than that of polyps smaller than 10 mm in diameter(0.90%-2/223,P<0.05).Conclusion: Patient with polypoid lesions of gallbladder that were larger than 10 mm in diameter,the coexistence of gallstones,sessile lesions,and over 60 years old should be suggested cholecytectomy.