胆囊息肉样病变临床病理学特征的回顾性研究
发布时间：2018-12-07 07:26
【摘要】：目的：鉴别胆囊息肉样病变中与肿瘤性息肉和恶性息肉相关的危险因素。 方法：对我科从2011年12月到2014年12月因胆囊息肉样病变收治入院行腹腔镜胆囊切除手术的329例患者的临床病理学资料进行回顾性研究分析。根据Christensen和Ishak提出的PLG病理分型可以将329例患者分为非肿瘤性息肉和肿瘤性息肉组。又根据手术标本的病理结果将329例患者分为良性息肉和恶性息肉组。分别比较分析组间患者的年龄、性别、症状、息肉数量和大小等临床特征。采用单因素分析和多因素Logistic回归分析方法确认与肿瘤性息肉和恶性息肉相关的危险因素,并对相关的计量资料绘制受试者工作特征曲线(ROC曲线),找到最佳临界值,并评估相关危险因素预测的准确性。 结果：单纯依据影像学检查难以区分肿瘤性和非肿瘤性息肉,以及良性息肉和恶性息肉。329例患者的基本情况如下,年龄最小为19岁,最大为77岁,平均年龄为45.5±12.3岁；男性患者135例(41%),女性患者194例(59%)；有右上腹痛等症状患者89例(27%),无相关症状患者240例(73%)；胆囊息肉单发147例(45%),多发(息肉数目有2个及2个以上)182例(55%)；胆囊息肉最大直径平均为1.19±0.37cm。非肿瘤性息肉277例(84.2%),腺瘤43例(13.1%),癌有9例(2.7%)。采用单因素分析方法,329例患者中,与非肿瘤性息肉患者相比,肿瘤性息肉患者在息肉数量(息肉单发,p=0.001)和息肉大小(大于1cm,p=0.032)等因素上的差异有统计学意义；与良性息肉患者相比,恶性息肉在息肉数量(息肉单发,p=0.002),息肉大小(大于1.5cm,p0.001),年龄(大于50岁,p=0.007),症状(有相关症状,p=0.02)等因素上的差异有统计学意义。而采用多因素Logistic回归分析方法,在肿瘤性息肉和非肿瘤性息肉组间,息肉数量(息肉单发,p=0.014),息肉大小(大于1cm,p0.001),年龄(大于50岁,p=0.008)等因素上的差异有统计学意义；在良性肿瘤和恶性肿瘤组间,息肉大小(大于1.5cm,p=0.011)和年龄(大于50岁,p=0.004)等因素上的差异有统计学意义。ROC曲线表明单纯用年龄和息肉大小来预测肿瘤性息肉的准确性不高；而用年龄和息肉大小来预测恶性息肉均有一定的准确性,最佳临界值分别为48.5和1.515。同时为了便于临床应用,将其分别调整为50和1.5。 结论：PLG患者大于50岁、息肉单发且直径大于1cm时要考虑到肿瘤性息肉的可能；当患者大于50岁且息肉直径超过1.5cm时要警惕恶性息肉的可能。
[Abstract]:Objective: to identify the risk factors associated with tumor polyps and malignant polyps in polypoid lesions of the gallbladder. Methods: the clinicopathological data of 329 patients with polypoid lesions of the gallbladder admitted to hospital for laparoscopic cholecystectomy from December 2011 to December 2014 were analyzed retrospectively. According to the PLG pathological classification proposed by Christensen and Ishak, 329 patients can be divided into nonneoplastic polyps and tumor polyps. According to the pathological results, 329 patients were divided into benign polyps and malignant polyps. The age, sex, symptom, number and size of polyps were compared between the two groups. Univariate analysis and multivariate Logistic regression analysis were used to identify the risk factors associated with tumor polyps and malignant polyps, and to draw the operating characteristic curve (ROC curve) for the relevant metrological data to find the best critical value. The accuracy of risk factor prediction was evaluated. Results: it was difficult to distinguish tumor polyps from non-tumor polyps, benign polyps and malignant polyps on the basis of imaging examination alone. The basic conditions of 329 patients were as follows: the minimum age was 19 years old, the maximum was 77 years old, the average age was 45.5 卤12.3 years. 135 cases (41%) were male, 194 cases (59%) were female, 89 cases (27%) were right epigastric pain and 240 cases (73%) were no related symptoms. There were 147 cases (45%) with single gallbladder polyps and 182 cases (55%) with multiple polyps (2 or more polyps), and the mean maximum diameter of polyps was 1.19 卤0.37 cm. There were 277 cases of nonneoplastic polyps (84.2%), 43 cases of adenoma (13.1%) and 9 cases of cancer (2.7%). Using univariate analysis, the number of polyps (single polyp, p0. 001) and the size of polyps (> 1 cm) in 329 patients with tumor polyps were compared with those of patients with nonneoplastic polyps. There were significant differences in factors such as p0. 032). Compared with patients with benign polyps, malignant polyps were found in the number of polyps (single polyp, p0. 002), polyp size (> 1. 5 cm, p0. 001), age (over 50 years, p0. 007), and symptoms (associated symptoms). There were significant differences in factors such as p0. 02). Using multivariate Logistic regression analysis, the number of polyps (single polyp, p0. 014), the size of polyps (more than 1 cm-1 p0. 001) and the age (older than 50 years) were observed in the patients with tumor polyps and non tumor polyps. There were significant differences in factors such as p0. 008). In benign and malignant tumor groups, polyp size (greater than 1.5 cm p0. 011) and age (older than 50 years), The ROC curve showed that the accuracy of age and polyp size in predicting tumor polyps was not high. However, age and polyp size have some accuracy in predicting malignant polyps, the best critical values are 48. 5 and 1. 515, respectively. In order to facilitate clinical application, it was adjusted to 50 and 1.5 respectively. Conclusion: the possibility of tumor polyps should be taken into account when PLG patients are over 50 years old and polyps are single and larger in diameter than 1cm, and the possibility of malignant polyps should be taken into account when the patients are older than 50 years and the diameter of polyps is larger than 1.5cm.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.4
本文编号：2366818
[Abstract]:Objective: to identify the risk factors associated with tumor polyps and malignant polyps in polypoid lesions of the gallbladder. Methods: the clinicopathological data of 329 patients with polypoid lesions of the gallbladder admitted to hospital for laparoscopic cholecystectomy from December 2011 to December 2014 were analyzed retrospectively. According to the PLG pathological classification proposed by Christensen and Ishak, 329 patients can be divided into nonneoplastic polyps and tumor polyps. According to the pathological results, 329 patients were divided into benign polyps and malignant polyps. The age, sex, symptom, number and size of polyps were compared between the two groups. Univariate analysis and multivariate Logistic regression analysis were used to identify the risk factors associated with tumor polyps and malignant polyps, and to draw the operating characteristic curve (ROC curve) for the relevant metrological data to find the best critical value. The accuracy of risk factor prediction was evaluated. Results: it was difficult to distinguish tumor polyps from non-tumor polyps, benign polyps and malignant polyps on the basis of imaging examination alone. The basic conditions of 329 patients were as follows: the minimum age was 19 years old, the maximum was 77 years old, the average age was 45.5 卤12.3 years. 135 cases (41%) were male, 194 cases (59%) were female, 89 cases (27%) were right epigastric pain and 240 cases (73%) were no related symptoms. There were 147 cases (45%) with single gallbladder polyps and 182 cases (55%) with multiple polyps (2 or more polyps), and the mean maximum diameter of polyps was 1.19 卤0.37 cm. There were 277 cases of nonneoplastic polyps (84.2%), 43 cases of adenoma (13.1%) and 9 cases of cancer (2.7%). Using univariate analysis, the number of polyps (single polyp, p0. 001) and the size of polyps (> 1 cm) in 329 patients with tumor polyps were compared with those of patients with nonneoplastic polyps. There were significant differences in factors such as p0. 032). Compared with patients with benign polyps, malignant polyps were found in the number of polyps (single polyp, p0. 002), polyp size (> 1. 5 cm, p0. 001), age (over 50 years, p0. 007), and symptoms (associated symptoms). There were significant differences in factors such as p0. 02). Using multivariate Logistic regression analysis, the number of polyps (single polyp, p0. 014), the size of polyps (more than 1 cm-1 p0. 001) and the age (older than 50 years) were observed in the patients with tumor polyps and non tumor polyps. There were significant differences in factors such as p0. 008). In benign and malignant tumor groups, polyp size (greater than 1.5 cm p0. 011) and age (older than 50 years), The ROC curve showed that the accuracy of age and polyp size in predicting tumor polyps was not high. However, age and polyp size have some accuracy in predicting malignant polyps, the best critical values are 48. 5 and 1. 515, respectively. In order to facilitate clinical application, it was adjusted to 50 and 1.5 respectively. Conclusion: the possibility of tumor polyps should be taken into account when PLG patients are over 50 years old and polyps are single and larger in diameter than 1cm, and the possibility of malignant polyps should be taken into account when the patients are older than 50 years and the diameter of polyps is larger than 1.5cm.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.4
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