基于不同病理分级的48例胆囊腺瘤临床特点分析

Analysis of clinical characteristics of 48 cases of gallbladder adenoma based on different pathological grades

目的探讨不同病理分级的胆囊腺瘤临床特点和腺瘤癌变的危险因素。方法回顾性分析48例胆囊腺瘤的临床资料,将胆囊腺瘤进行病理分级及癌变风险分组,分别对不同病理分级及癌变风险组中的性别、年龄、是否合并临床症状、是否合并胆囊结石、是否单发息肉、息肉大小、CEA及CA199等临床特点进行分析。结果根据胆囊腺瘤不同病理分级分为3组,分别是单纯胆囊腺瘤24例(50%),胆囊腺瘤并低级别上皮内瘤变17例(35.4%),胆囊腺瘤并高级别上皮内瘤变7例(14.6%),其中高级别上皮内瘤变组中黏膜内局灶癌变2例;胆囊腺瘤伴上皮内瘤变的发生率为50%,胆囊腺瘤的总体癌变率为4.2%(2/48);在其临床特点中,年龄、合并临床症状及息肉大小在不同病理分级间差异有统计学意义(P<0.05)。在单纯胆囊腺瘤及腺瘤伴上皮内瘤变组中,年龄、合并临床症状及息肉大小在两组之间差异有统计学意义(P<0.05);应用多因素二元Logistic回归分析显示,年龄(OR=5.716,95%CI:1.387~23.564)及息肉大小(OR=4.442,95%CI:1.057~18.675)是胆囊腺瘤发生上皮内瘤变及癌变的危险因素。结论胆囊腺瘤半数伴有不同级别的上皮内瘤变表现,具有一定的恶变潜能。

Objective To investigate the clinical characteristics and canceration risks of gallbladder adenoma with different pathological grades. Methods The clinical data of 48 cases of gallbladder adenoma were retrospectively analyzed. The patients were divided into different groups according to the pathological grades and canceration risks. Gender, age, associated clinical symptoms, complicated gallstones, single polyp, polyp size, CEA and CA199 were analyzed. Results According to the pathological grades, the patients were divided into 3 groups: simple gallbladder adenoma group(n=24, 50%), gallbladder adenoma with low-grade intraepithelial neoplasia group(n=17, 35.4%), and gallbladder adenoma with high-grade intraepithelial neoplasia group(n=7, 14.6%), which included 2 cases of intramucosal focal carcinoma. The incidence of gallbladder adenoma with intraepithelial neoplasia was 50%, and the overall cancerization rate was 4.2%(2/48). Among the clinical characteristics, age, associated clinical symptoms and polyp size showed significant statistical differences among gallbladder adenoma with different pathological grades(P<0.05). There were significant statistical differences in age, associated clinical symptoms and polyp size between the simple gallbladder adenoma group and intraepithelial neoplasia groups(P<0.05). According to binary Logistic regression analysis, age(OR=5.716, 95%CI: 1.387-23.564) and polyp size(OR=4.442, 95%CI: 1.057-18.675) were the risk factors of canceration. Conclusion Half of gallbladder adenomas are complicated with different grades of intraepithelial neoplasia, with a certain malignant potential.