胆囊息肉样病变748例分析

Management of polypoid lesions of the gallbladder： an analysis of 748 patients

目的 探讨胆囊息肉样病变（PLG）中肿瘤性息肉的危险因素及PLG的手术指征,了解胆囊腺瘤的临床特点.方法 回顾性分析1998年1月至2012年12月在浙江大学医学院附属第二医院因腹部超声发现PLG并行胆囊切除术的748例患者的临床病理资料.结果 748例患者中,340例患者具有腹部症状.病理报告提示659例为非肿瘤性息肉,68例为胆囊腺瘤,15例为胆囊癌,6例术后胆囊标本及病理均未发现息肉.非肿瘤性病变组病变平均直径为（9.38±3.44） mm,肿瘤性息肉组为（14.55±5.71）mm （P ＜0.01）.两组患者平均年龄分别为（44.14±11.42）岁和（47.39±12.82）岁（P＜0.05）,单发息肉比例分别为41.4％ （253/611）和59.59％ （47/79） （P ＜0.01）.胆囊腺瘤、胆囊癌患者息肉大小[（13.34±4.18）mm比（20.07±8.19） mm,P＜0.05]、平均年龄[（45.78±11.66）岁比（54.13±15.82）岁,P＜0.05],差异具有统计学意义,且66.7％（10/15）胆囊癌患者病理标本可见胆囊腺瘤或者异型增生细胞.结论 有腹部症状,息肉直径大于10 mm,年龄大于50岁,息肉为单发的PLG患者需要手术治疗.胆囊腺瘤可能发展为胆囊癌,大约需要10年.

Objective To investigate the risk factors of gallbladder neoplastic polyps,to determine the proper surgical indications,and to understand more about the clinical characteristics of gallbladder adenoma.Methods The clinical data of 748 patients diagnosed to have polypoid lesion of gallbladder （PLG） and underwent cholecystectomy from January 1998 to December 2012 in the Second Affiliated Hospital of Zhejiang University School of Medicine were retrospectively reviewed.Results Among 748 patients,340 had abdominal symptoms.Postoperative histopathology showed non-neoplastic polyps （n =659）,gallbladder adenoma （n =68）,gallbladder cancer （n =15） and no polyps （n =6）.The mean diameters of the nonneoplastic lesions and the neoplastic polyps were （9.38 ± 3.44） mm and （14.55 ± 5.71） mm,respectively （P 〈 0.01）.The average age of the patients with non-neoplastic lesions was （44.14 ± 11.42） years and （47.39 ± 12.82） years in those with neoplastic polyps （P 〈 0.05）.The proportion of solitary PLG was 41.4% （253/611） and 59.59% （47/79） for the non-neoplastic lesions and the neoplastic polyps respec tively （P 〈 0.01）.The size of PLG （13.34 ± 4.18 mm vs.20.07 ± 8.19 mm,P 〈 0.05） and the age of the patient （45.78 ± 11.66 years vs.54.13 ± 15.82 years,P 〈0.05） between the gallbladder adenoma and gallbladder cancer groups were significantly different.Gallbladder adenoma or dysplasia was identified in 66.7% （10/15） of gal1bladder cancer specimens.Conclusions Patients with PLG and with abdominal symptoms,large size （≥ 10 mm）,old age （≥50 y） and solitary polyp are indications for cholecystectomy.Gallbladder adenoma may develop to gallbladder cancer within 10 years.