胆囊息肉样病变的手术指征探讨

Operative Indications of Polypoid Lesions of Gallbladder

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。

Objeetive ：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 peduneulated 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% -2/993 ,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 eholecytectomy.