胆囊息肉样病变的临床处理

发布时间：2018-04-24 17:30

本文选题：胆囊疾病 + 息肉　；参考：《浙江大学》2015年硕士论文

【摘要】：目的：胆囊息肉样病变(polypoid lesion of gallbladder, PLG)是胆囊较为常见而又经常被忽略的疾病,同时部分外科医师对PLG的认识不足而盲目进行手术治疗,给患者及社会带来了不小负担。目前PLG的手术指征较为混乱,本文试图研究PLG中肿瘤性息肉的危险因素、胆囊腺瘤的临床特点及PLG随访患者的特点,分析探讨较为合理的手术指征及随访策略。方法：回顾性分析1998年1月至2012年12月于浙江大学医学院附属第二医院行腹部超声发现PLG并入院治疗的患者816例,分析其中行胆囊切除术并获得病理结果的748例患者的临床病理资料,并结合既往文献分析,提出合理的胆囊息肉样病变的处理方案。结果：748例患者平均年龄44.49±11.62岁,息肉平均大小为9.97±4.01mm。341例有症状。病理报告659例为非肿瘤性息肉,68例为胆囊腺瘤,15例为胆囊癌,另有6例为慢性胆囊炎。非肿瘤性病变组息肉最大直径平均(9.38±3.44mm)小于肿瘤性息肉组(14.55±5.71mm)(P0.01)；两组PLG患者平均年龄(44.14±11.42岁和47.39±12.82岁)、单发性息肉比例(41.4%和59.59%)差异均具有统计学意义(P0.05)。胆囊腺瘤、胆囊癌患者的息肉大小(13.34±4.18mm比20.07±8.19mm)、平均年龄(45.78±11.66岁比54.13±15.82岁)差异具有统计学意义(P0.05),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。对于小于10mm而进行随访并最终行手术明确为肿瘤性息肉的患者,其从发现PLG至手术的时间短于非肿瘤PLG患者(P0.05),而在息肉增大大小、息肉增大率等方面两组差异无统计学意义(P0.05)。结论：我们建议有腹部症状,病变最大径大于10mm的PLG患者需要手术治疗,而具有年龄大于50岁,单发息肉,合并有结石等危险因素的PLG患者在综合考虑后可行手术治疗,其余患者建议进行长期的随访。
[Abstract]:Objective: polypoid lesion of gallbladder (PLGs) is a common and often neglected disease of gallbladder, and some surgeons blindly operate on PLG because of their lack of understanding of PLG, which brings great burden to patients and society. At present, the surgical indications of PLG are confused. This paper attempts to study the risk factors of tumor polyps in PLG, the clinical characteristics of gallbladder adenoma and the characteristics of PLG follow-up patients, and to analyze the reasonable surgical indications and follow up strategies. Methods: from January 1998 to December 2012, 816 patients with PLG were examined by abdominal ultrasound in the second affiliated Hospital of Zhejiang University School of Medicine. The clinicopathological data of 748 patients undergoing cholecystectomy and obtaining pathological results were analyzed. Results the mean age of 748 patients was 44.49 卤11.62 years old and the mean size of polyps was 9.97 卤4.01mm.341. Pathological findings showed that 659 cases were nonneoplastic polyps 68 cases were gallbladder adenoma 15 cases were gallbladder carcinoma and 6 cases were chronic cholecystitis. The mean maximum diameter of polyps was 9.38 卤3.44 mm in the non-neoplastic lesions group (P < 0.01), and the average age of the patients with PLG was 44.14 卤11.42 years old and 47.39 卤12.82 years old, and the proportion of single polyps was 41.4% and 59.59 mm respectively. There were significant differences between the two groups (P < 0.05), and the average age of the patients with PLG was 44.14 卤11.42 years old and 47.39 卤12.82 years old, and the proportion of single polyps was 41.4% and 59.59 mm respectively. The size of polyps in patients with gallbladder adenoma and gallbladder carcinoma was 13.34 卤4.18mm vs 20.07 卤8.19 mm, and the mean age was 45.78 卤11.66 years vs 54.13 卤15.82 years old. For the patients who were followed up less than 10mm and finally operated as tumor polyps, the time from the discovery of PLG to surgery was shorter than that of non-tumor PLG patients (P 0.05), but there was no significant difference between the two groups in the enlargement and size of polyps and the increase rate of polyps in the two groups (P 0.05). Conclusion: we suggest that patients with PLG with abdominal symptoms and the maximum diameter of lesion larger than 10mm should be treated surgically, while PLG patients with age over 50 years old, single polyp and complicated with stones and other risk factors should be treated surgically after comprehensive consideration. Long-term follow-up is recommended for the rest of the patients.
【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】：R735.8

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