397例胆囊息肉样病变超声的诊断价值及随访结果

Value of Ultrasonography for the Diagnosis of Polypoid Lesion of the Gallbladder:Report of 397 Cases with Follow-up Data

目的评估超声检查发现的胆囊息肉样病变(polypoid lesions of the gallbladder,PLG)的病理类型和自然病程,为合理处理PLG提供临床依据。方法回顾分析我院1996～2008年397例超声检查发现的PLG的临床资料(不包括可疑胆囊癌患者),分析接受胆囊切除术患者病变的病理类型,随访患者息肉大小和数量的变化。结果随访120例,中位时间21个月(3～81个月),7例息肉继续增长(息肉直径增大3～6mm,平均3.5mm),103例息肉无变化,10例息肉变小或消失。80例接受胆囊切除者中,26例(32.5%)未见明确息肉(正常胆囊9例,慢性胆囊炎8例,胆石病9例);46例(57.5%)为非肿瘤性息肉(胆固醇性息肉33例,炎性息肉3例,腺肌瘤样增生10例);腺瘤8例(10.0%),其中1例息肉直径14mm手术标本中发现原位癌。1例原位癌随访1年,无肿瘤复发及转移。结论超声检查发现的病变直径≤10mm的PLG很少有伴随症状,无癌变患者可继续观察。

Objective To assess the natural history and histological characteristics of ultrasonography-detected polypoid lesions of the gallbladder （PLG）, so that to provide a guidance of the clinical diagnosis and treatment of the diseases. Methods Retrospective research was made on 397 patients with PLG detected by abdominal ultrasonography from 1996 to 2008 in our hospital. Patients with infiltrative masses suspicious for gallbladder cancer were excluded from this study. In patients who underwent cholecystectomy, histological findings were analyzed, and the change in polyp size was determined in patients who underwent serial ultrasonography imaging. Results Totally 120 patients achieved a medium of 21 months follow-up （ranged from 3 to 81 months）, during the period, 7 cases had the polyps increased by 3-6 mm in diameter （mean, 3.5 mm）; 103 patient showed no changes, while 10 patients had the polyp reduced or disappeared. In the patients, 80 cases received cholecystectomy, and 26 of them （32.5%） showed no polyp during the surgery （normal gallbladder was detected in 9 cases, chronic cholangitis was found in 8 patients, and cholelithiasis in 9 cases）; 46 of the 80 patients （57.5%） showed non-tumor polyps including 33 cases of cholesterol polyp, 3 cases of inflammatory polyp, and 10 cases of adenomatoid proliferation; 8 of the 80 patients （10.0%） were diagnosed as having adenoma. In one patients, in-situ carcinoma was detected in a sample polyp with a diameter of 14 mm. This patient was followed up for one year, durig which no metastasis or recurrence occurred. Conclusion PLG≤10 mm in diameter detected by ultrasonography are infrequently associated with symptoms and can be monitored without treatments.