Lee Kit Fai, Wong John, Li Jimmy Chak Man, Lai Paul Bo San
Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China.
Am J Surg. 2004 Aug;188(2):186-90. doi: 10.1016/j.amjsurg.2003.11.043.
Polypoid lesions of the gallbladder encompass a wide variety of pathology. Although most of these lesions are benign, some early carcinomas of the gallbladder do present as polypoid lesions. Problems remain in selecting patients with polypoid lesions of the gallbladder for surgery, the operative approach, and the method of follow-up of those deemed not needing surgery.
This review was done by Medline search of the English literature by the keywords "polypoid lesions of gallbladder," "gallbladder polyps," "carcinoma of gallbladder," and "benign tumors of gallbladder."
Most small polypoid lesions of the gallbladder are benign and remain static for years. Three- to six-monthly ultrasonography examination is warranted in the initial follow-up period but it is probably unnecessary after 1 or 2 years. Age more than 50 years and size of polyp more than 1 cm are the two most important factors predicting malignancy in polypoid lesions of the gallbladder. Other risk factors include concurrent gallstones, solitary polyp, and symptomatic polyp. Laparoscopic cholecystectomy is the treatment of choice unless the suspicion of malignancy is high, in which case it is advisable to have open exploration, intraoperative frozen section, and preparation for extended resection.
胆囊息肉样病变包含多种病理类型。尽管这些病变大多为良性，但一些早期胆囊癌确实表现为息肉样病变。在选择胆囊息肉样病变患者进行手术、手术方式以及对那些被认为无需手术者的随访方法方面，仍存在问题。
本综述通过对英文文献进行Medline检索，关键词为“胆囊息肉样病变”“胆囊息肉”“胆囊癌”和“胆囊良性肿瘤”。
大多数胆囊小息肉样病变是良性的，且多年保持稳定。在最初的随访期内，每三至六个月进行超声检查是必要的，但1或2年后可能就不必要了。年龄超过50岁和息肉大小超过1厘米是预测胆囊息肉样病变恶性的两个最重要因素。其他危险因素包括合并胆结石、单发息肉和有症状的息肉。除非高度怀疑恶性，否则腹腔镜胆囊切除术是首选治疗方法，在这种情况下，建议进行开放探查、术中冰冻切片检查并做好扩大切除的准备。
