对胆囊息肉样病变外科处理的思考

Thought on the surgical treatment of polypoid lesions of gallbladder

胆囊息肉的检出率越来越高。为了预防癌变或者避免漏诊胆囊癌，目前主流的做法是对大于1cm的息肉行胆囊切除术，而保胆手术则是把息肉大于0．5cm作为手术指征。这2个手术指征未必合理，因为按照该标准切除的胆囊息肉，大部分是不会癌变的胆固醇息肉。过早干预意味着过度医疗。同时，手术有出现严重并发症的风险。对胆固醇息肉患者而言，手术意味着额外的风险与创伤，得不偿失。因此，应该从严掌握胆囊息肉的手术指征，仅对胆囊息肉的高危人群做出手术选择。

The detection rate of polypoid lesions of gall- bladder has increased. In order to prevent malignancy or to a- void missed diagnosis of gallbladder carcinoma, the mainstream of the current practice is recommended for choleeysteetomy if polyps are larger than 1 cm, and polyps larger than 0. 5 cm is the indication for gallbladder-preserving operation. But the re- commendations mentioned above are not quite reasonable, be- cause most of polyps removed are the cholesterol ones which rarely become malignant. Besides, early intervention may lead to over-treatment and high risk of serious complications after sur- gery. Thus, surgery may bring additional trauma and risks to pa- tients with cholesterol polyps of the gallbladder. Taken together, we should strictly determine the operation indications for gall- bladder polyps and surgery may be appropriate for high-risk pa- tients only.