Yang H L, Sun Y G, Wang Z
Department of Surgery, First Affiliated Hospital, Zhejiang Medical University, Hangzhou, China.
Br J Surg. 1992 Mar;79(3):227-9. doi: 10.1002/bjs.1800790312.
One hundred and eighty-two patients with an ultrasonographic and/or pathological diagnosis of polypoid lesions of the gallbladder (PLG) were reviewed to determine the reliability of ultrasonography in the diagnosis of PLG and the indications for operation in this disease. Of the 182 patients operated on, PLG were demonstrated by the gross appearance of the resected gallbladder in 172. Histologically benign lesions were present in 159 gallbladders and malignant lesions in 13. Cholesterol polyps accounted for most benign PLG. The sensitivity of ultrasonography in detecting PLG was 90.1 per cent, significantly higher than that of oral cholecystography, computed tomography or endoscopic retrograde cholangiopancreatography (P less than 0.01). The specificity of ultrasonography in the diagnosis of PLG was 93.9 per cent. Therefore, ultrasonography is a highly sensitive method for investigating PLG, and the preoperative diagnosis of PLG in this unit has now become entirely dependent on this technique. The size and number of PLG, the presence of gallstones and the patient's age all correlate with the nature of PLG, and these features are helpful in differentiating malignant from benign lesions before operation. Surgical treatment is indicated when PLG exceed 1.0 cm in diameter, when PLG are single in number, when PLG are associated with gallstones, when patients with PLG are over the age of 50 years, or when clinical symptoms of PLG are apparent.
回顾了182例经超声和/或病理诊断为胆囊息肉样病变（PLG）的患者，以确定超声检查在PLG诊断中的可靠性以及该疾病的手术指征。在182例接受手术的患者中，172例经切除胆囊的大体外观证实存在PLG。组织学上，159个胆囊为良性病变，13个为恶性病变。胆固醇息肉占大多数良性PLG。超声检查检测PLG的敏感性为90.1%，显著高于口服胆囊造影、计算机断层扫描或内镜逆行胰胆管造影（P<0.01）。超声检查诊断PLG的特异性为93.9%。因此，超声检查是研究PLG的一种高度敏感的方法，本单位目前对PLG的术前诊断完全依赖于该技术。PLG的大小和数量、胆结石的存在以及患者的年龄均与PLG的性质相关，这些特征有助于在手术前区分恶性和良性病变。当PLG直径超过1.0 cm、数量为单个、与胆结石相关、PLG患者年龄超过50岁或PLG出现临床症状时，应进行手术治疗。
