胆囊息肉样病变的病理分类与超声检查特点  

Pathologic sort of ultrasonic diagnosis by polypoid lesions of the gallbladder and risk factors of gallbladder malignant disease

作　　者：张毅[1] 郑淑芳[1] 袁梅[1] 张积华[1] 王正滨[1] 

机构地区：[1]青岛大学医学院附属医院健康体检中心,266003

出　　处：《中华普通外科学文献（电子版）》2011年第5期13-17,共5页Chinese Archives of General Surgery(Electronic Edition)

摘　　要：目的分析胆囊息肉样病变(PLG)不同病理学类型的超声改变特点,探讨恶性病变的危险因素。方法回顾性分析由超声诊断并经手术和病理组织学证实的84例PLG直径≥10mm的临床资料。根据组织病理学结果将PLG分为良性组和恶性组,分析PLG病理学分类的超声诊断,评估胆囊恶性病变的危险因素。结果 84例PLG超声诊断敏感性98.81%,特异性89.29%,准确性94.05%,阳性预测值为88.10%,阴性预测值89.29%,误诊率为10.71%(9/84)。恶性组(44例)与良性组(40例)在年龄(67.5岁vs.45.5岁)、合并胆囊结石(27.27%vs.12.50%)、PLG单发(97.14%vs.75.00%)、直径(35.2mmvs.15.6mm)、基底部宽(97.73%vs.67.50%)、彩色多普勒血流成像(CDFI)呈高阻低速型动脉血流频谱(84.00%vs.23.08%)、阻力指数(RI)(≥0.60vs.≤0.35)等指标比较差异有统计学意义(P<0.05)。结论 PLG直径≥10mm超声诊断与手术及病理学分类的符合率较高,对其良恶性的鉴别具有较高的临床价值。年龄≥60岁、PLG单发、基底部宽、直径≥20mm、CDFI高阻低速型动脉血流频谱、RI≥0.60及合并胆囊结石是胆囊恶性病变的危险因素,其中PLG直径是独立的高危因素。超声可作为鉴别和评估胆囊良恶性病变的重要方法之一。Objective To discuss base of pathological sort and ultrasonic diagnosis in diameter ≥ 10 mm polypoid lesions of the gallbladder （PLG） risk factors of gallbladder malignant disease. Methods Clinical data of 84 cases with ultrasonic and surgery pathological examination of PLG in diameter ≥10 mm were retrospectively analyzed. They were divided into malignant group and benign group diagnosis with operation and pathologic of PLG, ultrasonic diagnosis and pathologic sort, evaluate risk factor of the gallbladder malignant disease were analyzed. Results For the 84 cases with PLG, the sensitivity of ultrasonic diagnosis was 98.81%, the specificity was 89.29% and the accuracy was 94.05%. The positive predictive value was 88.10% and the negative predictive value was 89.29%, the rate error diagnosis was 10.71%. Benign group were 40 cases （47.62%）, malignant group were 44 cases （52.38%）. Analyzed with index of two group, the malignant group were older（67.5 years vs. 45.5 years）, with gallbladder stone （27.27% vs. 12.50%）, single lesion （97.14% vs. 75.00%）, diameter （35.2 mm vs. 15.6 mm）, bounty of the floor （97.73% vs. 67.50%）, color Doppler flow imaging （CDFI） of high resistance artery （84.00% vs. 23.08%） and character and resistine index （RI） （ ≥ 0.60 vs. ≤ 0.35） and so on, P〈 0.05. Conclusions Diagnosis of operation and pathology for PLG with the diameter ≥10 mm is higher accord with ultrasonic. Risk factors for malignant PLG are ≥ 60 age, single, bounty of the floor, diameter ≥20 mm, CDFI show blood stream of artery, RI≥0.60 and gallbladder stone. Ultrasonic diagnosis may he an important method to evaluate and differentiate of gallbladder malignant disease.

关 键 词：胆囊息肉样病变 恶性病变 病理分类 超声诊断 

分 类 号：R445.1[医药卫生—影像医学与核医学]