397例胆囊息肉样病变超声的诊断价值与随访结果.doc

397例胆囊息肉样病变超声的诊断价值及随访结果 刁其先 （青岛海慈医院外科，青岛 266033） [摘要]目的 评估超声检查发现的胆囊息肉样病变（PLG）的自然病程和病理类型，以便指导胆囊息肉样病变的临床诊断和治疗。方法 回顾397例超声检查发现胆囊息肉样病变的临床资料（不包括可疑胆囊癌患者），分析接受胆囊切除术患者病变的病理类型，并观察随诊患者息肉大小和数量的变化情况。结果 随访120例，中位时间21个月(3～81个月)，7例发现息肉继续增长(息肉直径增大3～6mm，3.5mm)，103例息肉无变化，10例息肉变小或消失。80例接受胆囊切除者中，26例（32.5%）未见明确息肉（正常胆囊9例，慢性胆囊炎8例，胆石病9例）；46例（57.5%）为非肿瘤性息肉（胆固醇性息肉33例，炎性息肉3例，腺肌瘤样增生10例）；腺瘤8例（10.0%），其中1例息肉直径14 mm手术标本中发现原位癌。1例原位癌随访1年，无肿瘤复发及转移。结论 超声检查发现的小的胆囊息肉病变（病变直径≤10mm）很少有伴随症状，可继续观察。侵袭性癌的发生率非常低，本研究中未发现。 [关键词]胆囊息肉样病变；超声检查；胆囊切除术 Abstract Objective：To assess the natural history and the histologic characteristics of US-detected PLG, to guide clinical diagnosis and treatment. Methosds：Retrospective research was done to patients with PLG detected by abdominal US. Eliminate patients with infiltrative masses suspicious for gallbladder cancer. In patients who underwent cholecystectomy, histologic findings were analyzed, and change in polyp size was determined in patients who underwent serial US imaging. Results：From 1997 to 2008, 420 patients were identified with PLG detected by US. 230 patients (55%) were women, and median age was 60 years (range 20 to 94 years). 266 patients (64%) were found to have PLG during the workup of other unrelated disease; 95 patients (23%) had abdominal symptoms. 94% patients’ PLG≤10 mm; 59% of patients had a single polyp and 12% had gallstones. Among 143 patients who had repeat US followup, growth was observed in only 8 patients (6%). 80 patients had cholecystectomy, and among them most patients had either pseudopolyps (58%) or no polyp (32%). in the last10% of patients adenoma were found. In situ cancer was seen in one patient with a 14-mm lesion. Conclusions：PLG≤10 mm in diameter detected by US are infrequently associated with symptoms and can be safely observed. The incidence of invasive cancer is very low, and not seen in our study. Key words: polypoid lesions of the gallbladder(PLG), ultrasonography(US), cholecystectomy 胆囊息肉样病变（polypoid lesions of the gallbladde