Prevalence and risk factors of gallbladder polypoid lesions in Chinese petrochemical employees

AIM:To investigate the prevalence and risk factors of polypoid lesions of the gallbladder (PLGs) in petrochemical employees in Ningbo, Zhejiang Province, China. METHODS:All active and retired employees aged 20-90 years (n = 11098) of a refinery and chemical plant in eastern China were requested to participate in a health survey. The participants were subjected to interview, physical examination, laboratory assessments and ultrasonography. All the participants were invitedto have a physical examination after a face-to-face interview. Fasting blood samples were obtained from the antecubital vein, and the samples were used for the analysis of biochemical values. Abdominal ultrasonography was conducted. RESULTS:A total of 10461 (7331 men and 3130 women) current and former petrochemical employees attended for screening. The overall prevalence of postcholecystectomy, gallstones and PLGs was 0.9%, 5.2% and 7.4%, respectively. Compared with the increased prevalence of either gallstones or post-cholecystectomy in older persons, PLGs were more common in the middle-aged, peaking in those aged 40-59 years. Excluding the patients with gallstones, gallstones mixed with PLGs, or those who had undergone cholecystectomy, in the remaining 9828 participants, the prevalence of PLGs in men (8.9%) was significantly higher than that in women (5.5%, P < 0.001). The analyzed risk factors with increased OR for the development of PLGs were male gender (OR = 1.799, P < 0.001), age ≥ 30 years (OR = 2.699, P < 0.001) and hepatitis B surface antigen (HBsAg) positivity (OR = 1.374, P = 0.006). CONCLUSION:PLGs are not rare among Chinese petrochemical employees. Male gender, HBsAg positivity, and middle age are risk factors for developing PLGs.

Diagnosis and treatment of polypoid lesions of the gallbladder:report of 194 cases

BACKGROUND: With the wide use of B-ultrasonography in recent years, the polypoid lesion of the gallbladde ( PLG) has been one of the most common diseases detected in biliary surgery. This study was to investigate the diag nostic method and operative indications of PLG. METHODS: The clinical and pathological data of 194 pa tients with PLG who had received operation at our hospita from January 1994 to September 2002 were analyzed retro spectively. Categorized data were analyzed by the chi square test. RESULTS: All the patients received preoperative B-ultra- sonography. 185 of the 194 PLG patients were diagnosed as having cholecystic polyp, and 9 adenomas. Among the 42 patients who received CT, 6 showed early gallbladder can cer. Pathologically, cholesterol polyps were mostly multi ple lesions (64.7%) with a mean diameter of3.86±2.2 mm in 136 patients. Of 16 patients with adenomas, 10 had a tumor diameter of more than 10 mm (62.5%). In 11 pa tients with gallbladder carcinoma, 7 were accompanied with gallbladder stone (63.6%). In addition, inflammatory polyps and adenomyomas were found in 25 and 6 patients respectively. CONCLUSIONS: B-ultrasonography is the most effective diagnostic method for detecting PLG. When large or irreg- ular lesions are found, CT should be performed in order to avoid missing of gallbladder carcinoma. Operative indica- tions for PLG include; a maximal tumor diameter of more than 10 mm; an over 50-year-old patient with a wide-base and a single polyp lesion; a wide-base lesion or a lesion showing a tendency to enlargement; co-existing gallbladder stone or cholecystitis; a patient without other diseases but obvious clinical features and failure of general ma- nagement ; big or long pedicels or polyps at the neck of the gallbladder for preventing the empty of the gallbladder and a history of biliary colic; and PLG with irregularly thick- ened local gallbladder wall.

DIAGNOSIS AND TREATMENT OF POLYPOID LESIONS OF THE GALLBLADDER

This article reports 56 pathologically confirmed cases of polypoid lesions of the gallbladder (PLG) that were operated on in our hospital from 1984 to 1995. The patients' ages ranged from 10 to 70 and the mean age was 43. 5, 83.9% were 30～49 years old. Gallstone could be round in 24cases. There were 36 cases of pseudotumor in this group (64.2% ), 20 of true tumor(35. 8% ) and 1of carcinopolypus. The diagnosis rate was elevated with the use or BUS. The patients with complicated gallstone and polyp in the neck of gallbladder should be operated early while asymptom patients could be followed and operated on at sultable stage.

PATHOLOGIC STUDY OF PRECANCEROUS LESION OF THE GALLBLADDER

Precancerous lesions of the gallbladder in 150 consecutive cholecystectomy specimens resected from the patients with cholelithiasis or cholecystitis were studied. Of these specimens, 80% had simple epithelial hyperplasia, 16% atypical hyperplasia, 1.3% carcinoma in situ and 2.7% invasive carcinoma. Atypical hyperplasia was observed in the mucosa abjacent to carcinoma in situ which, in turn, was found in the mucosa adjacent to invasive carcinoma. This finding suggests that some of simple hyperplasia of the gallbladder evolve towards atypical hyperplasia, carcinoma in situ which finally becomes invasive carcinoma. In addition, the authors provide a morphologic criteria for grading the atypical hyperplasia of the gallbladder.

Endoscopic ultrasonography does not differentiate neoplastic from non-neoplastic small gallbladder polyps

AIM： To assess the ability of endoscopic ultrasonography （EUS） to differentiate neoplastic from non- neoplastic polypoid lesions of the gallbladder （PLGs）.METHODS： The uses of EUS and transabdominal ultrasonography （US） were retrospectively analyzed in 94 surgical cases of gallbladder polyps less than 20 mm in diameter.RESULTS： The prevalence of neoplastic lesions with a diameter of 5-20 mm was 27.2% （10/58）; 22-15 mm, 25.4% （4/26）, and 16-20 mm, 50% （5/20）. The overall diagnostic accuracies of EUS and US for small PLGs were 80.9% and 63.9% （P 〈 0.05）, respectively. EUS correctly distinguished 12 （63.2%） of 19 neoplastic PLGs but was less accurate for polyps less than 1.0 cm （4/10, 40%） than for polyps greater than 1.0 cm （8/9, 88.9%） （P = 0.02）.CONCLUSION： Although EUS was more accurate than US, its accuracy for differentiating neoplastic from non-neoplastic PLGs less than 1.0 cm was low. Thus, EUS alone is not sufficient for determining a treatment strategy for PLGs of less than 1.0 cm.

Assessment of tumor markers CA 19-9,CEA,CA 125,and CA 242 for the early diagnosis and prognosis prediction of gallbladder cancer

BACKGROUND Gallbladder cancer(GBC)is one of the leading and aggressive cancers in this region of India.It is very difficult to diagnose in the early stage,as it lacks typical early signs and symptoms;thus,the diagnosis is often in the advanced stage,which ultimately leads to a poor 5-year survival outcome.Tumor markers including carbohydrate antigen 19-9(CA 19-9),carcinoembryonic antigen(CEA),CA 125,CA 242,and alpha fetoprotein are used as indicators in the diagnosis and prognosis of GBC.AIM To compare tumor marker levels between GBC and benign GB diseases(GBDs)and to assess the combined use of tumor markers to increase the diagnostic accuracy for GBC.METHODS Patients of either sex aged≥18 years,with suspected GBC(GB polyp,irregular thick GB wall,GB mass,porcelain GB)on the basis of radiological imaging were included in this study.GB wall thickness using ultrasonography and tumor markers CEA,CA 125,CA 19-9,and CA 242 in all patients were recorded.All cases after surgical intervention were divided into two groups,GBC and benign GBD,according to histopathological examination findings.The cases were followed up and clinical findings,radiological findings,and levels of tumor markers were assessed.RESULTS A total of 200 patients were included in this study,of whom 80 patients had GBC and 120 patients had benign GBD.The median(interquartile range)age was 52.0(41.0-60.0)years and the majority of patients(132,66.0%)were women.Tumor markers including CA 19-9,CA 125,CEA,and CA 242 were significantly elevated in patients with GBC(P<0.001).There was a significant reduction in tumor markers at 3 and 6 mo from baseline(P<0.001).The mean survival of patients with normal and elevated levels of tumor markers CA 125,CA 19-9,and CEA was comparable;however lymph node metastasis and CA 242 expression level were independent prognostic factors.CONCLUSION Serum levels of tumor markers including CA 19-9,CA 125,CEA,and CA 242 were significantly associated with GBC.However,no significant association was observed between the presence of elevated levels of any tumor marker with respect to survival.Tumor marker assessment during follow-up may represent a treatment response.

低频与高频超声联合诊断胆囊息肉样病变价值分析

目的探讨高频和低频超声联合检查诊断胆囊息肉样病变(PLG)的价值。方法2020年5月~2023年4月我院诊治的PLG患者64例,术前均接受低频超声和高频超声检查,行腹腔镜下胆囊切除术,术中留取组织行病理学检查。以Kappa系数评价超声诊断与组织病理学检查诊断的一致性。结果在64例PLG患者中,经组织病理学检查诊断良性病变59例和恶性病变5例;超声检查恶性病变单发、宽基底和发现有血流信号百分比分别为80.0%、80.0%和80.0%,均显著高于良性病变的44.1%、33.9%和27.1%(P<0.05);经低频超声诊断恶性病变9例(14.1%)、良性病变55例(85.9%),经高频超声诊断恶性病变8例(12.5%)、良性病变56例(87.5%),经高频/低频超声联合诊断恶性病变7例(10.9%)、良性病变57例(89.1%),三种方法诊断结果比较差异无统计学意义(P>0.05);高频/低频超声联合诊断病变良恶性的敏感度、特异度和准确率分别为100.0%、96.6%和71.4%,与组织病理学诊断结果的一致性较高(kappa=0.817)。结论鉴于高频与低频超声各有优缺点,两者联合诊断PLG病变性质可能能提高诊断的准确性,值得不断尝试。

腹腔镜下行胆囊切除术治疗胆囊息肉样病变的临床效果及应激反应分析

目的评估腹腔镜下胆囊切除术(Laparoscopic Cholecystectomy,LC)应用在胆囊息肉样病变(Polypoid Lesions of The Gallbladder,PLG)患者中的临床效果及对应激反应的影响。方法随机选取2019年12月—2022年12月三明市第一医院收治的80例PLG患者为研究对象,参照随机数表法分为对照组[40例,实施开腹胆囊切除术(Open Cholecystectomy,OC)治疗]、观察组(40例,行LC治疗)。评价两组手术相关参数、应激反应、炎症反应以及术后并发症发生率。结果与对照组相比,观察组手术相关参数更佳,差异有统计学意义(P<0.05)。术前,两组应激反应[包括血糖(Blood Glucose,BG)、皮质醇(Cortisol,Cor)、肾上腺素(Epinephrine,E)]、炎症因子[包括C反应蛋白(C-Reactive Protein,CRP)、白细胞介素-6(Interleukin-6,IL-6)、白细胞介素-8(Interleukin-8,IL-8)]比较,差异无统计学意义(P均>0.05);术后1 d,观察组应激反应指标(BG、Cor、E)、炎症因子(CRP、IL-6、IL-8)水平低于对照组,差异有统计学意义(P均<0.05)。观察组术后并发症发生率(2.50%)低于对照组(20.00%),差异有统计学意义(χ^(2)=6.135,P=0.013)。结论对PLG患者实施LC,可以减轻应激反应、炎症反应,减少术中出血量、手术时间及术后并发症,加快术后恢复速度。

彩色多普勒超声对胆囊息肉样病变的诊断价值分析

目的分析胆囊息肉样病变应用彩色多普勒超声的诊断价值。方法选择胆囊息肉样病变患者50例,所有患者均接受彩色多普勒超声检查。以病理诊断结果作为金标准,分析彩色多普勒超声对胆囊息肉样病变的诊断符合率及影像学特点。结果彩色多普勒超声对胆固醇性息肉、胆囊腺瘤、炎症性息肉、胆囊腺肌瘤样增生、早期胆囊癌的诊断符合率分别为95.45%、83.33%、100.00%、87.50%、100.00%。胆固醇性息肉可发生于胆囊各部位,大小为≤10 mm,属多发,基底窄/有蒂,形状为结节/桑葚状,局部胆囊壁正常,无血流,显示高回声;胆囊腺瘤多发生于胆囊底部,大小为10~16 mm,属单发,基底宽,形状为团块状,局部胆囊壁增厚,无血流,显示中等回声;炎症性息肉也可发生于胆囊各部位,大小为5~13 mm,属多发,基底宽,形状不规则,局部胆囊壁毛糙,无血流,显示高回声;胆囊腺肌瘤样增生多发生于胆囊底部与颈部,大小为9~17 mm,属单发,基底正常/宽,形状为球状,局部胆囊壁正常,有血流,显示低回声/无回声;早期胆囊癌多发生于胆囊底部与颈部,大小为11~25 mm,属单发,基底宽,形状为团块,局部胆囊壁正常,有血流,显示低回声/混合回声。结论在胆囊息肉样病变患者中实施彩色多普勒超声诊断的符合率较高,结合患者的影像学特点有助于明确疾病类型,为后续治疗提供参考。

高频超声联合彩色多普勒超声检查诊断胆囊息肉样病变的价值

目的:评估高频超声联合彩色多普勒超声检查在胆囊息肉样病变(polypoid lesions of gallbladder,PLG)诊断中的应用价值。方法:选取北京电力医院在2022年4月-2023年8月收诊的108例PLG患者作为研究对象,采用高频超声(探头频率7.5-11.0MHz)与彩色多普勒超声(探头频率34.5MHz)对其进行联合检查。所有患者在入院后接受检查,并随后接受手术治疗,以手术探查和术中冰冻组织病理检查结果为金标准。结果:高频超声联合彩色多普勒超声检查在PLG良恶性鉴别诊断中表现出更高的诊断准确率、灵敏度和特异度,且对PLG不同病理组织类型的诊断符合率也优于单一检查(P<0.05);对于PLG良恶性病灶的病灶形态、病灶直径、病灶回声特点、病灶数量、胆囊壁增厚概率、病灶内有血流信号概率的比较,差异均有统计学意义(P<0.05)。结论:高频超声联合彩色多普勒超声检查是诊断PLG的有效方法,有助于早期检出PLG的良恶性,值得临床推广应用。

低频联合高频超声在胆囊息肉样病变中的诊断价值分析

目的探讨低频联合高频超声在胆囊息肉样病变(PLG)中的诊断价值,以期为临床准确制定防治对策提供科学依据。方法选择93例PLG患者为调查对象,均接受低频超声、低频联合高频超声检查与手术病理检查。记录手术病理结果,统计低频超声单独检查、低频联合高频超声检查对PLG的检出结果,并以手术病理结果为PLG诊断金标准,分析低频超声、低频联合高频超声检查PLG的诊断效能,分析低频超声、低频联合高频超声诊断PLG的结果和病理结果之间一致性。结果93例PLG患者经手术病理检查发现良性PLG者77例(82.80%)、恶性PLG者16例(17.20%);低频联合高频超声检查对PLG的诊断灵敏度(93.75%)略高于低频超声单独检查(75.00%),差异无统计学意义(P>0.05);低频联合高频超声检查对PLG的诊断特异度(92.21%)、准确度(92.47%)均高于低频超声单独检查(71.43%、72.04%),差异有统计学意义(P<0.05);低频超声诊断PLG结果和手术病理结果之间一致性较差(Kappa=0.321,P=0.000),低频联合高频超声诊断PLG结果和手术病理结果之间呈高度一致性(Kappa=0.765,P=0.000)。结论低频联合高频超声用于临床诊断PLG的应用价值高,能减少误诊和漏诊,为临床制定防治对策提供准确依据。

超声造影联合高频彩色多普勒超声检查鉴别诊断胆囊息肉样病变良恶性的效能

目的:观察超声造影联合高频彩色多普勒超声检查鉴别诊断胆囊息肉样病变良恶性的效能。方法:回顾性分析2022年3月至2023年3月该院收治的78例胆囊息肉样病变患者的临床资料,根据病理活检结果,将其分为良性组48例和恶性组30例。两组均行高频彩色多普勒超声检查和超声造影检查,比较两组高频彩色多普勒超声图像特征、超声造影参数(开始增强时间、达峰时间),以及高频彩色多普勒超声、超声造影单项及联合检查鉴别诊断胆囊息肉样病变良恶性的效能。结果:恶性组多发息肉占比、息肉有血流占比以及息肉最大直径均高于良性组,差异有统计学意义(P<0.05);恶性组开始增强时间、达峰时间均短于良性组,差异有统计学意义(P<0.05);超声造影联合高频彩色多普勒超声检查诊断恶性胆囊息肉样病变的灵敏度高于两者单项检查诊断,漏诊率低于两者单项检查诊断,差异均有统计学意义(P<0.05)。结论:超声造影联合高频彩色多普勒超声检查鉴别诊断胆囊息肉样病变良恶性的效能高于两者单项检查诊断效能。

石家庄地区表观健康人群胆囊息肉样病变的危险因素

目的:探讨石家庄地区表观健康人群胆囊息肉的发病率及相关危险因素。方法:回顾性分析石家庄地区2021年7月~2022年4月表观健康体检人群的相关资料,共纳入符合标准的体检人群为13254人,其胆囊息肉样病变患者为1733例(13.1%),按照有无胆囊息肉分为胆囊息肉组(PLG组)和非胆囊息肉组(非PLG组),并将两组临床资料进行统计分析。结果:研究表明,年龄、体重指数(BMI)、收缩压(SBP)和空腹血糖(GLU)与胆囊息肉的形成密切相关(P<0.05);经二元Logistic回归分析后证实BMI为胆囊息肉的独立危险因素。结论:BMI为本地区胆囊息肉发病的独立危险因素。

胆囊隆起性病变超声造影特征与临床病理学特点的相关性分析

目的分析胆囊隆起性病变超声造影特征与临床病理学特点的相关性。方法回顾性选取2019年7月至2022年7月克拉玛依市中心医院收治的疑似胆囊隆起样病变患者60例作为研究对象。所有患者均进行超声造影检查,以病理诊断结果为金标准,分析超声造影特征及超声造影对胆囊隆起性病变的诊断价值。采用Pearson检验分析临床病理学特点、超声造影特征与胆囊隆起样病变之间的相关性。采用多因素Logistic回归分析影响胆囊隆起样病变形成的独立危险因素。结果胆囊隆起性病变在增强程度、动脉期血管分型方面差异有统计学意义(P<0.05)。经一致性分析证实,超声造影评估胆囊隆起性病变的敏感度为96.43%,特异度为87.50%,准确率为91.67%,阳性预测值为87.10%,阴性预测值为96.55%,Kappa值为0.728。胆囊隆起性病变直径≤10 mm者占41.67%(25/60),显著高于胆囊隆起性病变直径>10 mm者[8.33%(5/60)],差异有统计学意义(P<0.05)。Pearson相关性检验显示,超声造影增强程度、动脉期血管分型为点状型、分支血管型、病变直径与胆囊隆起性病变形成均呈正相关(r=0.714、0.726、0.733、0.726,P<0.05)。多因素Logistic回归分析结果显示,超声造影增强程度、动脉期血管分型为点状型、分支血管型、病变直径是胆囊隆起性病变形成的独立危险因素(P<0.05)。结论超声造影增强程度、动脉期血管分型为点状型、分支血管型,病变直径是胆囊隆起性病变形成的独立危险因素,可作为胆囊隆起性病变形成的提示因素,值得在临床上应用。

CT影像组学和机器学习预测胆囊息肉样病变性质的研究

目的探讨不同机器学习的影像组学模型预测胆固醇性胆囊息肉和腺瘤性胆囊息肉的价值。方法回顾性分析2015年9月至2022年9月我院100例经手术病理证实的胆固醇性息肉和腺瘤性息肉患者的临床及影像资料。基于术前增强CT提取的影像组学特征,训练集采用T检验和最小绝对收缩和选择算子交叉验证法进行特征筛选。然后用3种机器学习方法(人工神经网络、逻辑回归和支持向量机)构建预测模型,利用ROC曲线下面积、准确率以及F1度量值评估3种模型的预测能力,并通过验证集进行验证。结果人工神经网络算法在基于10个影像组学特征的息肉病变性质鉴别模型中预测效果最好,具有最高的曲线下面积(训练集为1;验证集为0.81)、准确率(训练集为1;验证集为0.83)及F1度量值(训练集为1;验证集为0.76)。10个影像组学特征中,基本特征1个、小波特征9个。结论基于增强CT的机器学习影像组学模型有助于预测胆固醇性胆囊息肉和腺瘤性胆囊息肉的病变性质,为两者的定性诊断及治疗方式的选择提供依据。

胆囊CEUS联合肝脏MRI检查对胆囊息肉样病变患者的诊断价值

目的:探讨胆囊超声造影(CEUS)联合肝脏核磁共振成像(MRI)检查对胆囊息肉样病变(PLG)患者的诊断价值。方法:选取122例PLG患者为研究对象,依据组织病理检测结果分为良性病变组(n=55)和恶性病变组(n=67)。比较两组患者CEUS及MRI检查结果,分析胆囊CEUS与肝脏MRI单独、联合检查对胆囊息肉良恶性病变的诊断效能。结果:CEUS检查结果显示,恶性病变组胆囊壁厚度大于良性病变组(P<0.05);胆囊壁不连续、高增强占比高于良性病变组(P<0.05);始增时间、达峰时间、消退时间短于良性病变组(P<0.05)。MRI检查结果显示,恶性病变组弥散加权成像(DWI)信号强度高于良性病变组(P<0.05);表观弥散系数(ADC)值低于良性病变组(P<0.05)。以组织病理结果为“金标准”,胆囊CEUS联合肝脏MRI诊断PLG恶性病变的敏感度、特异度、准确度分别为92.54%、90.91%、91.80%,一致性检验Kappa值为0.83。结论:胆囊CEUS联合肝脏MRI在PLG良恶性病变的鉴别诊断中具有较高的诊断效能。

膜解剖的腹腔镜下胆囊全层切除术治疗胆囊局灶性病变的安全性分析

目的探讨利用Laennec膜行腹腔镜下胆囊全层切除术治疗胆囊局灶性病变的临床应用安全性。方法回顾性分析于2021年6月至2022年1月在海宁市人民医院行腹腔镜下胆囊全层切除术22例(胆囊全层切除术组)及腹腔镜下胆囊切除术30例(常规手术组)患者的病例资料。比较两组手术时间、术中出血量、术后住院时间及术后并发症情况。结果两组均顺利完成手术,胆囊全层切除术组手术时间较常规手术组长[(55.40±18.01)min vs(43.40±7.11)min,t=2.961,P=0.002];两组术中出血量[20.00(5.00,30.00)mL vs 17.50(5.00,37.50)mL,Z=-0.465,P=0.642]、术后住院时间[(2.77±0.42)d vs(2.60±0.49)d,t=1.118,P=0.134]差异均无统计学意义,术后均无需要临床干预的并发症发生。结论腹腔镜下胆囊全层切除术是安全可行的,且能避免切入胆囊,可用于胆囊良性局灶性病变的治疗。

超声造影鉴别直径≥1 cm胆囊病变良恶性的价值分析

目的:探讨超声造影,即对比增强超声(contrast-enhanced ultrasound,CEUS)对于鉴别直径≥1 cm胆囊病变良、恶性的价值。方法:对经手术病理确诊、增强CT/MRI检查或随访2年以上临床诊断的142个直径≥1 cm胆囊病变的CEUS资料,进行回顾性分析,总结直径1 cm以上胆囊良、恶性病变的CEUS特性,参考胆囊CEUS相关指南标准计算鉴别胆囊病变良、恶性诊断效能,并将CEUS标准分别与造影剂35 s前消退、60 s前消退联合,计算相应的诊断效能。结果:恶性组CEUS增强模式、增强开始时间、增强消退时间、胆囊壁连续性等方面与良性组比较,差异均有统计学意义(P<0.001)。良、恶性组总体增强水平的差异有统计学意义(P<0.001)。依据CEUS标准诊断胆囊恶性病变的灵敏度93.0%、特异度83.8%、准确率86.6%。CEUS标准联合造影剂35 s前消退诊断胆囊恶性病变的灵敏度、特异度、准确率上升至93.0%、92.9%、93.0%。结论:CEUS鉴别直径≥1 cm胆囊病变良、恶性有较高价值,结合35 s前造影剂消退有助于提高鉴别胆囊病变良恶性的能力。

高频超声联合彩色多普勒超声诊断胆囊息肉样病变价值分析

目的 分析高频超声联合彩色多普勒超声检查诊断胆囊息肉样病变的价值。方法 2019年4月~2022年4月我院诊治的胆囊息肉样病变(PLG)患者71例,使用HD11型高频超声和SONOLINE Premier型彩色多普勒超声检查,所有患者接受腹腔镜下胆囊息肉切除术,取组织行病理学检查。以后者为金标准,采用Kappa系数检验,分析高频超声联合彩色多普勒超声检查的诊断价值。结果 在71例PLG患者中,经组织病理学检查,诊断为良性病变67例,腺癌4例;高频超声联合彩色多普勒超声检查诊断为良性病变66例(98.5%),高频超声或彩色多普勒超声检查诊断分别为64例(95.5%)和63例(94.0%),无显著性差异(P>0.05);使用高频超声联合彩色多普勒超声检查诊断PLG的敏感度、特异度、准确率分别为98.5%、100.0%和98.6%,与组织病理学检查的一致性(Kappa=0.881),显著高于高频超声诊断(分别为95.5%、75.0%、94.4%,Kappa=0.571)或彩色多普勒超声检查诊断(94.0%、75.0%、93.0%,Kappa=0.510)。结论 使用高频超声联合彩色多普勒超声检查诊断和判断胆囊息肉样病变性质的准确度较高,能够指导临床作出合适的处理决定。

超声造影在胆囊隆起样病变诊断中的应用进展

胆囊隆起样病变分为肿瘤性病变和非肿瘤性病变两大类。肿瘤性病变包括胆囊腺瘤和胆囊癌;非肿瘤性病变包括胆固醇性息肉、炎性息肉、胆囊腺肌症等。常规超声检查是诊断胆囊病变的首选影像学方法,但诊断能力有限。随着医学技术的发展,超声造影在部分胆囊病变的应用中渐被认可。不同类型的胆囊隆起样病变在超声造影动脉期及静脉期病灶的增强程度、消退特点、增强模式、血管构型、胆囊壁的连续性方面表现不同。对比剂达峰时,病灶增强的均质性在鉴别胆囊腺瘤与1 cm以上胆固醇息肉有较高的诊断效能,其灵敏度、特异度、阳性预测值、阴性预测值、准确率分别为100%、90.9%、92.9%、100%、95.8%。超声造影对胆囊腺肌症特征性结构罗-阿窦的显示率从常规超声的22.0%上升到56.1%;在胆囊腺瘤诊断中,超声造影检查具有较高的灵敏度和特异度,分别为84.6%和87.0%;超声造影诊断黄色肉芽肿性胆囊炎的灵敏度、特异度、阴性预测值分别为90%、93%、94%。病灶形态不规则、树枝状血管、静脉期低增强是提示胆囊腺癌的3个特异性超声造影征象,结合任意2个或3个征象,诊断胆囊癌的特异度可达92.4%。在胆囊隆起样病变的诊断中,超声造影表现具有一定特征,具有较高的应用价值。