胆囊息肉样病变的诊治

目的 探讨胆囊息肉样病变的诊治原则。方法 回顾研究342例胆囊息肉样病变病例的临床、病理特点。结果 良性息肉共328例,包括胆固醇性息肉234例、单纯腺瘤74例;恶性息肉14例,包括腺癌10例、腺瘤恶变4例。有症状者247例,占72．2％。恶性息肉中年龄大于50岁者占78．6％,息肉最大径大于lcm者占91．7％,息肉为单发者占100％;而在非恶性息肉中分别为29．9％、13．2％、46％,差异均有显著性(p=0．000)。结论 胆固醇性息肉、腺瘤、腺癌是3种最常见的胆囊息肉样病变。对于有症状者应行手术治疗。年龄大于50岁、最大径大于1锄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、考虑手术。

Diagnosis and treatment of polypoid lesion of the gallbladder

To discuss the principles of diagnosis and treatment of the polypoid lesion of gallbladder. Methods Clinical and pathological features of 342 cases were analysed. Results Totally 328 patients with benign polypoid lesions(including 234 cholesterol polyps, and 74 adenomas), and 14 patients with malignant polypoid lesions(including 10 adenocarcinomas and 4 adenomas with malignant changes)were included. Two hundred and forty-seven cases(72.2%)had symptoms. Seventy-eight point six percent of patients with malignant polyps were over 50 years of age, and while 29.9 percent of patients with non-malignant polyps were over 50 years. The lesions were more than 1 cm in 91.7% of the malignant polyps and in only 13.2% of the benign polyps. One hundred percent of malignant polyps, and 46 percent of benign polyps were single polyp. Conclusions Cholesterol polyps, adenomas, and adenocarcinomas are the most common lesions in polypoid lesion of the gallbladder. Cholecystectomy should be done in patients with symptoms. The risk factors for malignancy are the age of the patient(> 50), the size(>1 cm),and number(single)of the polypoid lesions. In asymptomatic patients, cholecystectomy can be justified after integrated analysis.