胆囊息肉样病变直径对判断息肉性质的价值分析*

目的 探讨胆囊息肉直径对判断息肉性质的价值。方法 2010年1月～2019年3月我科诊治的胆囊息肉患者420例,接受开放或腹腔镜胆囊切除术治疗。采用多因素Logistic回归分析胆囊癌发生的危险因素,绘制受试者工作特征曲线(ROC曲线),计算不同胆囊息肉直径预测息肉恶变的曲线下面积(AUC)、敏感性和特异性。结果 经术后组织病理学检查,诊断良性胆囊息肉388例,恶性胆囊息肉32例;良性胆囊息肉患者年龄为(46.6±8.7)岁,显著小于恶性胆囊息肉患者;良性胆囊息肉直径为6(2,27)mm,显著小于恶性胆囊息肉直径;良恶性息肉患者性别构成、胆囊息肉数目、胆囊结石、癌胚抗原、CA19-9和空腹血糖等均无显著性统计学差异(P>0.05);经多因素分析,发现胆囊息肉直径是胆囊癌发生的独立危险因素(P<0.05,OR=1.52,95%CI:1.36～1.69);绘制胆囊息肉直径ROC曲线,得出AUC为0.89(0.85～0.93),即当息肉直径为13 mm时,诊断胆囊癌的敏感性和特异性分别为91.0%和71.8%。结论 胆囊息肉直径预测胆囊癌的价值较高,当息肉直径>13 mm时,因恶变风险增大,建议手术治疗。

Diameters of gallbladder polyp in forecasting carcinogenesis

Objective The aim of this study was to investigate the clinical value of diameters of gallbladder polyp in forecasting carcinogenesis.Methods 420 patients with gallbladder polyps were recruited in our hospital between January 2010 and March 2019,and all patients underwent open or laparoscopic cholecystectomy.Multivariate Logistic regression analysis was applied to determine the risk factors of gallbladder carcinogenesis.The area under ROC curve(AUC)was drawn for sensitivity and specificity in predicting the malignant transformation of polyps with different diameters of gallbladder polyps.Results 388 patients had benign and 32 had malignant gallbladder polyps proven by post-operational histopathological examination;the age of patients with benign gallbladder polyps was(46.6±8.7)years,significantly younger than(52.6±11.4)years,P<0.05]in patients with malignant gallbladder polyps;the diameter of benign gallbladder polyps was 6(2,27)mm,significantly less than16(8,34)mm,P<005]in patients with malignant gallbladder polyps;there were no significant differences as respect to gender,number of gallbladder polyps,gallstone,serum carcinoembryonic antigen and CA19-9 levels and fasting blood glucose between patients with benign and malignant polyps;the multivariate analysis showed that the diameter of gallbladder polyps was an independent risk factor affecting the nature of gallbladder polyps(P<0.05,OR=1.52,95%CI:1.36-1.69);the ROC curve analysis demonstrated that the AUC was 0.89(0.85 to 0.93),e.g.when the diameter of polyps was equal to 13 mm,the diagnostic sensitivity and specificity were 91.0%and 71.8%,respectively.Conclusions The diameter of gallbladder polyps is of high value in predicting gallbladder carcinoma.When the diameter is greater than 13 mm,the possibility of malignant transformation of gallbladder polyps is higher,and we recommend that the gallbladder polyps should be excised as soon as possible.