胆囊息肉手术适应证的多中心回顾性研究(附2272例报告)  

A multicenter retrospective study on surgical indications of gallbladder polyps:a report of 2272 cases

作　　者：张东[1] 李起 张小弟 贾蓬勃 王新团 耿西林[4] 张煜[4] 李军辉[5] 姚春和[6] 刘益民[7] 郭智华[7] 杨瑞[8] 雷达[9] 杨成林[10] 郝琪伟[11] 杨文彬[5] 耿智敏[1] Zhang Dong;Li Qi;Zhang Xiaodi;Jia Pengbo;Wang Xintuan;Geng Xilin;Zhang Yu;Li Junhui;Yao Chunhe;Liu Yimin;Guo Zhihua;Yang Rui;Lei Da;Yang Chenglin;Hao Qiwei;Yang Wenbin;Geng Zhimin(Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710061,China;Department of Hepatobiliary Surgery,No.215 Hospital of Shaanxi Nuclear Industry,Xianyang 712000,Shaanxi Province,China;Department of Hepatobiliary Surgery,the First People′s Hospital of Xianyang,Xianyang 712000,Shaanxi Province,China;Department of Hepatobiliary Surgery,Shaanxi Provincial People′s Hospital,Xi′an 710068,China;Department of General Surgery,the Second Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710004,China;Department of General Surgery,Xianyang Hospital of Yan′an University,Xianyang 712000,Shaanxi Province,China;Department of Hepatobiliary Surgery,People′s Hospital of Baoji,Baoji 721000,Shaanxi Province,China;Department of General Surgery,Hanzhong Central Hospital,Hanzhong 723000,Shaanxi Province,China;Department of Hepatobiliary Surgery,Baoji Central Hospital,Baoji 721000,Shaanxi Province,China;Department of General Surgery,Ankang Central Hospital,Ankang 725000,Shaanxi Province,China;Department of Hepatobiliary Surgery,Yulin No.2 Hospital,Yulin 719000,Shaanxi Province,China)

机构地区：[1]西安交通大学第一附属医院肝胆外科,710061 [2]陕西省核工业215医院肝胆外科,陕西咸阳712000 [3]咸阳市第一人民医院肝胆外科,陕西咸阳712000 [4]陕西省人民医院肝胆外科,西安710068 [5]西安交通大学第二附属医院普通外科,710004 [6]延安大学附属咸阳医院普通外科,陕西咸阳712000 [7]宝鸡市人民医院肝胆外科,陕西宝鸡721000 [8]汉中市中心医院普通外科,陕西汉中723000 [9]宝鸡市中心医院肝胆外科,陕西宝鸡721000 [10]安康市中心医院普通外科,陕西安康725000 [11]榆林市第二医院肝胆外科,陕西榆林719000

出　　处：《中华消化外科杂志》2020年第8期824-834,共11页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(81572420);陕西省重点研发计划(2017ZDXM⁃SF⁃055、2017KW⁃060)。

摘　　要：目的:探讨胆囊息肉的手术适应证。方法:采用回顾性病例对照研究方法。收集2015年1月至2019年12月11家医疗中心收治的2272例(西安交通大学第一附属医院585例、陕西省核工业215医院352例、咸阳市第一人民医院332例、陕西省人民医院233例、西安交通大学第二附属医院152例、延安大学附属咸阳医院138例、宝鸡市人民医院137例、汉中市中心医院125例、宝鸡市中心医院95例、安康市中心医院72例、榆林市第二医院51例)行手术治疗胆囊息肉患者的临床病理资料;男887例,女1385例;年龄为(48±12)岁,年龄范围为12~86岁。观察指标:(1)手术治疗、病理学检查及住院情况。(2)随访及并发症情况。(3)非肿瘤性息肉与肿瘤性息肉患者临床病理资料比较。(4)无胆囊结石且胆囊息肉直径为7~9 mm、10~12 mm、≥13 mm患者临床病理资料比较。(5)无胆囊结石且胆囊息肉直径为10~12 mm患者发生肿瘤性息肉的影响因素分析。(6)无胆囊结石且胆囊息肉直径为10~12 mm患者肿瘤性息肉列线图预测模型构建及评估。采用门诊或电话方式进行随访,了解患者术后并发症及生存状况。随访时间截至2020年4月。正态分布的计量资料以±s表示,组间比较采用t检验。偏态分布的计量资料以M(范围)表示,组间比较采用秩和检验。等级资料采用多样本秩和检验。剔除CEA、CA19-9缺失数据后进行发生肿瘤性息肉的影响因素分析。单因素分析采用x2检验或多样本秩和检验,多因素分析采用Logistic回归模型。经Logistic回归模型多因素分析后,应用R 3.6.0 version软件构建列线图预测模型。结果:(1)手术治疗、病理学检查及住院情况:2272例患者中,行腹腔镜胆囊切除术2199例、开腹胆囊切除术43例、胆囊癌根治术28例、腹腔镜保胆取息肉术2例,术中行快速冷冻切片病理学检查1050例。2272例患者中,术后病理学检查为非肿瘤性息肉1953例(胆�Objective:To investigate the surgical indications of gallbladder polyps.Methods:The retrospective case-control study was conducted.The clinicopathological data of 2272 patients with gallbladder polyps who underwent cholecystectomy in 11 medical centers from January 2015 to December 2019 were collected,including 585 in the First Affiliated Hospital of Xi′an Jiaotong University,352 in No.215 Hospital of Shaanxi Nuclear Industry,332 in the First People′s Hospital of Xianyang,233 in Shaanxi Provincial People′s Hospital,152 in the Second Affiliated Hospital of Xi′an Jiaotong University,138 in Xianyang Hospital of Yan′an University,137 in People′s Hospital of Baoji,125 in Hanzhong Central Hospital,95 in Baoji Central Hospital,72 in Ankang Central Hospital,51 in Yulin No.2 Hospital.There were 887 males and 1385 females,aged(48±12)years,with a range from 12 to 86 years.Observation indicators:(1)surgical treatment,pathological examination and hospitalization;(2)follow-up and complications;(3)comparison of clinicopathological data between patients with non-neoplastic polyps and neoplastic polyps;(4)comparison of clinicopathological data among patients who had gallbladder polyp diameter of 7 to 9 mm,10 to 12 mm,or≥13 mm without cholecystolithiasis;(5)analysis of influence factors for the incidence of neoplastic polyps in patients who had gallbladder polyp diameter of 10 to 12 mm without cholecystolithiasis;(6)construction and evaluation of nomogram prediction model for neoplastic polyps of patients who had gallbladder polyp diameter of 10 to 12 mm without cholecystolithiasis.Follow-up using outpatient examination or telephone interview was conducted to detect complications and survival of patients up to April 2020.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed using the t test.Measurement data with skewed distribution were represented as M(range),and comparison between groups was analyzed using the rank-sum test.Ordinal data was analyzed using

关 键 词：胆道良性疾病 胆囊息肉 肿瘤性息肉 非肿瘤性息肉 手术 影响因素 列线图 

分 类 号：R657.4[医药卫生—外科学]