胆囊息肉样病变的外科治疗体会(附234例报告)

SURGICAL TREATMENT OF GALLBLADDER POLYPOID LESION

目的 探讨胆囊息肉样病变 (GPL)的诊断及手术指手征。方法 对 B超和 (或 )病理诊断的胆囊息肉样病变 2 34例进行回顾性分析。结果 胆固醇性息肉病变表现为多发性 (87.5 % ) ,平均直径 <5 m m,肿瘤性息肉 (腺瘤 ,癌 ,腺肌瘤 )倾向于单发 ,直径在 5 mm- 35 mm。 1例腺瘤伴有粘膜上皮的不典型增生。结论 (1) B超是诊断 GPL 的最有效方法。 (2 )单发 ,年龄>5 0岁 ,直径 >10 m m或合并胆结石 ,出现相应并发征的 GPL 应行外科手术治疗。 (3)有明显临床症状者 ,经内科正规治疗无效且症状影响工作 ,生活者可考虑手术治疗。(4)对无症状 ,肿块直径 <5 mm者 ,可随访 B超进行定期观察 ,发现病变有增大趋势 。

Objective To investigate the diagnosis and treatment of gallbladder polyp lesion(GPL).Methods 234 cases of GPL confirmed by pathological examination were analyzed retrospectively.Results Cholesterol GPL were mostly of multiple foci(87.5%) with a mean diameter of <5mm.Turmoral polyps which included adenomas,carcinoma,adenomyonomas were presented of single focus.Conclusion ①B model ultrasonic examination was the most effective diagnosis method.②The patients older than 50 years with a single polyp lesion or complicated with gallbladder stone,pancreatitis,choledochal bleeding and choledochal fistula should be operated.③The patients with obvious clinical symptoms,who had had a formal internal medical treatment but without any effective should be considered to have a surgical intervention.④The patients without any symptems and with the GPL<5mm in diameter should be followed up closely,if the lesion presented an intention of enlargement,the surgical intervention should be taken in count.