超声诊断胆囊息肉样病变的临床体会

Ultrasound diagnosis on the apophysis lesions of gallbladder

目的探讨胆囊息肉样病变的超声诊断。方法回顾分析51例胆囊息肉样病变病例的超声特征、临床症状及病理类型。结果胆囊良性病变共43例（胆固醇息肉39例，腺肌症3例，炎性息肉1例），肿瘤性病变8例（腺瘤性息肉5例，恶性肿瘤3例）。无临床症状的32例患者中93．8％为胆固醇息肉（P〈0．05），有症状的21例患者中，8例合并结石，4例合并溃疡性疾病。3例（100％）腺肌症及4例（80％）腺瘤性息肉出现临床症状（P〈0．05）。多发息肉样病变患者中22例，均为良性病变，且95．5％病理为胆固醇性息肉。7例超声诊断为胆囊单发息肉病例，病理诊断提示有直径小于0．3cm的息肉。超声显示胆囊壁增厚共6例，腺肌症3例（壁厚0．5—1．8cm），胆囊恶性病变3例（壁厚0．5—1．2cm）。结论对于超声提示无症状的或者多发的胆囊息肉样患者，胆固醇性息肉是最常见的病变类型。超声对于直径小于0．3cm的胆囊息肉样病变不敏感但超声提示胆囊壁局限性增厚（〉0．5cm）者应警惕恶性肿瘤及腺肌症可能。

Objective To discuss the ultrasound diagnosis on the apophysis lesions of the gallbladder. Methods A retrospective analysis was made in 51 cases of polypoid lesions of gallbladder ultrasound char- acteristics of cases, clinical symptoms and pathological types. Results There were 43 cases of benign lesions （39 cases of cholesterol polyp, 3 cases of adenomyosis, 1 case of inflammatory polyps）, 8 cases of tumor lesions （5 cases of adenomatous polyp, 3 cases of malignant tumors）. Among those patients with out clinical symptoms （ n = 32 ） were for cholesterol polyps （ P 〈 0. 05 ） while in, with symptomatic patients （21 cases）, 8 were complicated with stone, 4 with ulcerative disease. Three cases （ 100% ） with adenomyosis and 4 cases （80%） with adenomatous polyposis shouwed symptoms （P 〈 0. 05）. Patients with multiple polypoid lesions （22 cases）, were benign lesions, and 95. 5% were pathologlicdly cholesterol polyp. Seven cases of ultrasound diagnosis of gallbladder polyps were pathologically diagnosed having polyp diameter smaller than 0. 3 cm. Ultrasound showed gallbladder wall thickening in 6 cases, 3 with adenomyosis （ wall thickness 0. 5 - 1.8 cm）, 3 with malignant lesions in gallbladder （wall thickness 0. 5 - 1.2 cm）. Conclusions For those patients uhrasound showed asymptomatic or multiple polyps of the gallbladder, cholesterol polyps are the most common type of lesion. Ultrasound is not sensitive to polypoid lesions of the gallbladder with diame- ter less than 0. 3 cm. Those with limited ultrasonic gallbladder wall thickening （ 〉 0. 5 cm） should pay more attention to the possibility of having malignant tumors and adenomyosis.