胆囊良性疾病的治疗现状与思考  

Treatment status and meditation of benign gallbladder diseases

作　　者：刘厚宝[1] 倪小健 沈盛[1] 郑博豪 刘寒[1] Liu Houbao;Ni Xiaojian;Shen Sheng;Zheng Bohao;Liu Han(Department of General Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院普通外科,上海200032

出　　处：《中华消化外科杂志》2020年第8期813-819,共7页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金面上项目(81872352);上海市徐汇区医学尖峰学科项目(SHXH201703)。

摘　　要：胆囊良性疾病是普通外科常见疾病,包括胆囊结石、胆囊息肉样病变、胆囊炎等。我国对该类疾病的治疗仍存在不规范,主要表现为:(1)一切了之,由此导致胆囊切除术后腹痛、腹胀、腹泻和胆管损伤等并发症发生率有所上升。(2)能保则保,对存在潜在胆囊癌高危因素的胆囊良性疾病未能及时施行规范的胆囊切除术,从而导致胆囊癌的发生,造成严重后果。特别是对胆囊良性疾病施行保胆手术,这是不科学的外科治疗,其术后胆囊可能成为发生胆囊癌的高危因素。对存在潜在胆囊癌高危因素的胆囊良性疾病及时施行规范的胆囊切除术,不仅可以显著降低胆囊癌的发病率,而且可以显著提高胆囊癌的早期诊断率,改善患者预后。笔者结合文献及自身临床实践,对胆囊良性疾病的治疗现状进行分析,对其手术适应证、手术时机和治疗方法的选择等方面存在的争议与问题进行思考和探讨。Benign gallbladder diseases are common diseases in general surgery,including gallstones,polypoid lesions,cholecystitis,etc.In China,the treatment of benign gallbladder diseases is still not standardized,which mainly shows in following aspects:(1)the tendency of cholecystectomy to all gallbladder diseases may result in the incidence of abdominal pain,distension,diarrhea and bile duct injury after surgery;(2)the attitude of“no-surgery”in which the standard cholecystectomy fails to implement in time for the benign gallbladder diseases with potential high-risk factors for gallbladder cancer,as a result,patients develop occurrence of gallbladder cancer.Especially,gallbladder sparing surgery is an unscientific surgery for benign gallbladder diseases,the gallbladder may become a high-risk factor for cancer after the operation.Implementation of standard cholecystectomy in time for benign gallbladder diseases with potential high risk gallbladder cancer can not only significantly reduce the incidence of gallbladder cancer,but also significantly improve the early diagnosis and the prognosis.Based on current literatures,the authors analyze the treatment status of benign gallbladder diseases,and investigate the disputes and problems in surgical indications,operation time and the selection of treatments of benign gallbladder diseases.

关 键 词：胆囊良性疾病 胆囊结石 胆囊息肉 胆囊炎 胆囊腺肌症 胆囊癌 治疗 胆囊切除术 

分 类 号：R657.4[医药卫生—外科学]