飞行员胆囊息肉影响飞行二例并文献复习

Two flying affected cases of the pilots with gallbladder and literature review

目的 探讨胆囊息肉对飞行人员飞行训练的影响及航空医学的鉴定原则. 方法 分析2例飞行员胆囊息肉的诊断、治疗、医学鉴定及健康等级评定,并复习相关文献. 结果 本组2例飞行员胆囊息肉在动态观察过程中,1例在12个月内增大6 mm,另1例在3个月内增大4 mm,均鉴定为暂时飞行不合格.送体系医院行胆囊切除术.病理检查提示前者为腺肌瘤,经1个月康复疗养及2个月地面观察,无身体不适,鉴定为飞行合格,健康等级为乙类.后者为腺瘤,经1个月康复疗养及2个月地面观察,偶尔出现腹泻及上腹部胀痛,鉴定为飞行合格,健康等级为乙类. 结论 胆囊息肉是飞行人员多发病,无症状静息性胆囊息肉在动态观察监测下可以放飞,但下列情况下的胆囊息肉应引起特别重视：①息肉引起腹痛、腹胀、恶心、呕吐等症状而影响飞行训练;②短期内息肉增大趋势明显;③息肉直径＞10 mm;④年龄＞50岁;⑤单发或广基、无蒂性息肉;⑥息肉合并胆囊结石.上述6种胆囊息肉中,凡具备前2项中的任意1项,后4项中的任意2项,息肉恶变风险增大,对飞行人员的身体健康和飞行训练工作存在不良影响,应暂时飞行不合格,及早去体系医院进一步诊断治疗.

Objective To discuss the influence of gallbladder polyps on the aircrews＇ flight training and the evaluation principle of aeromedicine.Methods Two cases of the pilots with gallbladder were analyzed on polyps diagnosis,treatment,medical evaluation and health rating of polyps and the relative documents were reviewed.Results The dynamic observation of two cases of pilot＇s gallbladder polyps showed that one of them increased by 6 mm in twelve months and the other increased by 4 mm in three months.Both pilots were evaluated as temporary grounding.They were sent to system hospital and received the cure of cholecystectomy.The pathological examination indicated the former case was adenomyoma.After one month rehabilitation recuperation and two months observation,no discomfort was found.So he was qualified and evaluated as second heath grade.The latter was an adenoma case.After one-month rehabilitation recuperation and two-month observation,even his diarrhea and upper abdomen pain were occasionally occurred,he was still qualified and his heath grade was evaluated as second level.Conclusions Gallbladder polyps is a frequently-occurring disease in aircrews.With dynamic monitoring and observation,pilots with asymptomatic resting gallbladder polyps could be qualified.But the gallbladder polyps with following conditions should be paid more attention on：①Polyps caused abdominal pain,abdominal distension,nausea,vomiting and other symptoms that affect flight training.②The polyp significantly increases in short term.③The diameter of polyp is more than 10 mm.④The age is older than 50 yr.⑤Single or broad-based sessile polyps.⑥ polyps complicated with cholecystolithiasis.In above six conditions related to gallbladder polyps,any one in the first two items and any two in the later four items involved indicate increasing malignancy risk and will bring negative impact on aircrews＇ health and flight training.So they should be temporarily grounded and sent to hospital for further diagnosis and treatment.