胆囊隆起样病变的诊治探讨(附203例报告)  

Investigation on the diagnosis and treatment of the apophysis lesions of gallbladder:report of 203 cases

作　　者：陈增银[1] 王一[1] 张东生[1] 史光军[1] 王占春[1] 

机构地区：[1]青岛大学医学院附属青岛市立医疗集团东部医院肝胆胰外科,山东青岛266071

出　　处：《肝胆胰外科杂志》2008年第2期115-118,共4页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的探讨胆囊隆起样病变的诊治原则。方法回顾分析203例手术切除胆囊隆起样病变病例的临床、病理特点。其中197例行术前B超检查,203例均行术后病理检查。结果胆囊良性病变共190例(胆固醇息肉128例,单纯腺瘤16例),98.0%的胆固醇息肉直径小于10mm,半数以上的胆固醇息肉为多发;腺瘤多为单发,平均直径为(6.0±3.4)mm;良性病变患者有症状者87.9%(167/190)。胆囊恶性病变13例(腺癌8例、乳头状腺癌5例),平均直径为(11.2±3.1)mm,年龄均大于55岁。结论对于B超提示的胆囊隆起样病变,胆固醇性息肉、腺瘤是最常见的良性病变,腺癌是最常见的恶性病变。对于有症状者应行手术治疗,年龄大于60岁、直径大于10mm以及合并结石的单发息肉是恶性病变的危险因素。对于无症状者,应综合分析,再决定是否手术。Objective To explore and discuss the principles of diagnosis and treatment about the apophysis lesions of the gallbladder. Methods Clinical and pathological features were analysed retrospectively in 203 cases. Results Totally 190 patients with benign apophysis lesions （including 128 cholesterol polyps and 16 adenoma） were included： the diameter of 98 percent of cholesterol polyps was less than 10 mm, and more then half of them were multiple; most adenoma were single polyp and the average diameter of them was （6.0_±3.4） mm; 87.9 percent of patients with benign lesions had symptoms （167/190）. 13 patients with malignant apophysis lesions （including 8 adenocarcinoma and 5 papillary adenoma） were included： the average diameter of gallbladder carcinoma was （11.2±3.1） mm; most malignant polyps were single polyp, and the age of all patients with malignant polyps was over 55 years. Conclusion Cholesterol polyp and adenoma are the most commen lesions in benign polypoid lesion of gallbladder; and adenocarcinoma is the most commen malignant lesions. Cholecystectomy should be done in patients with symptoms. The risk factors for malignancy are the age of the patient elder than 60, the size larger than 10 mm, and combined with stone. In asymptomatic patients, cholecystectomy can be justified after integrated analysis.

关 键 词：胆囊 隆起样病变 胆固醇息肉 腺瘤 诊断 治疗 

分 类 号：R657.4[医药卫生—外科学]