Babu Benoy I, Dennison Ashley R, Garcea Giuseppe
Leicester HPB Unit, University Hospitals of Leicester, Gwendolen Road, LE5 4PW, Leicester, UK,
Langenbecks Arch Surg. 2015 May;400(4):455-62. doi: 10.1007/s00423-015-1302-2. Epub 2015 Apr 25.
Recommendation for management of gallbladder polyps (GBPs) >1 cm is cholecystectomy. No consensus exists on management of GBPs <1 cm. This systematic review examines current evidence on management of GBPs.
MEDLINE, EMBASE and Cochrane library databases were searched from January 1991 to June 2013 using specified terms. A predefined protocol for data extraction was used to retrieve specified end points.
Literature search yielded 43 manuscripts with a dataset of 11,685 patients with GBPs. M:F ratio was 1.3:1. Average age (range) was 49 years (32-83). Patients with malignant GBPs had an average (range) age of 58 (50-66) years with M:F ratio of 0.78:1. Cholesterol polyps constituted 60.5% of GBPs followed by adenomas (15.2%) and cancer (11.6%). Malignant GBPs ≥1 cm, <1 cm and <5 mm constituted 8.5, 1.2 and 0% of GBPs, respectively. Majority of patients requiring surgical intervention had laparoscopic cholecystectomy.
Presently employed policy of cholecystectomy for GBPs >1 cm is appropriate. For GBPs <1 cm, the authors propose (accepting existence of differing proposals) the following: 1. Surveillance may not be needed for GBPs <5 mm. 2. For GBPs between 5 and 10 mm, two scans at six monthly intervals is suggested and after that, tailor surveillance to age, growth and ethnicity. In the non-Asian population, if GBP remains the same size or number, discontinuation of surveillance may be considered. In the Asian population, if GBPs remain the same, yearly surveillance is continued for a suggested period of 3 years. 3. Discontinue surveillance if GBPs is/are smaller/ disappeared. Cholecystectomy is advised where size increases to >10 mm.
对于直径大于1厘米的胆囊息肉（GBP），推荐的治疗方法是胆囊切除术。对于直径小于1厘米的GBP，目前尚无统一的治疗共识。本系统评价旨在研究GBP治疗的现有证据。
使用特定检索词对1991年1月至2013年6月期间的MEDLINE、EMBASE和Cochrane图书馆数据库进行检索。采用预先定义的数据提取方案来获取特定的终点指标。
文献检索共获得43篇手稿，数据集包含11,685例GBP患者。男女比例为1.3:1。平均年龄（范围）为49岁（32 - 83岁）。恶性GBP患者的平均年龄（范围）为58岁（50 - 66岁），男女比例为0.78:1。胆固醇息肉占GBP的60.5%，其次是腺瘤（15.2%）和癌症（11.6%）。直径大于等于1厘米、小于1厘米和小于5毫米的恶性GBP分别占GBP的8.5%、1.2%和0%。大多数需要手术干预的患者接受了腹腔镜胆囊切除术。
目前对于直径大于1厘米的GBP采用胆囊切除术的策略是合适的。对于直径小于1厘米的GBP，作者建议（承认存在不同建议）如下：1. 直径小于5毫米的GBP可能无需监测。2. 对于直径在5至10毫米之间的GBP，建议每隔6个月进行两次扫描，之后根据年龄、生长情况和种族调整监测方案。在非亚洲人群中，如果GBP大小或数量不变，可以考虑停止监测。在亚洲人群中，如果GBP大小不变，建议每年监测，持续3年。3. 如果GBP变小/消失，则停止监测。如果大小增加到大于10毫米，建议进行胆囊切除术。
