Bhatt Nikita R, Gillis Amy, Smoothey Craig O, Awan Faisal N, Ridgway Paul F
Department of Surgery, University of Dublin, Trinity College, at the Adelaide and Meath Hospital, Tallaght, Dublin, Ireland.
School of Mechanical and Materials Engineering, University College Dublin, Ireland.
Surgeon. 2016 Oct;14(5):278-86. doi: 10.1016/j.surge.2015.12.001. Epub 2016 Jan 26.
There are no evidence-based guidelines to dictate when Gallbladder Polyps (GBPs) of varying sizes should be resected.
To identify factors that accurately predict malignant disease in GBP; to provide an evidence-based algorithm for management.
A systematic review following PRISMA guidelines was performed using terms "gallbladder polyps" AND "polypoid lesion of gallbladder", from January 1993 and September 2013. Inclusion criteria required histopathological report or follow-up of 2 years. RTI-IB tool was used for quality analysis. Correlation with GBP size and malignant potential was analysed using Euclidean distance; a logistics mixed effects model was used for assessing independent risk factors for malignancy.
Fifty-three articles were included in review. Data from 21 studies was pooled for analysis. Optimum size cut-off for resection of GBPs was 10 mm. Probability of malignancy is approximately zero at size <4.15 mm. Patient age >50 years, sessile and single polyps were independent risk factors for malignancy. For polyps sized 4 mm-10 mm, a risk assessment model was formulated.
This review and analysis has provided an evidence-based algorithm for the management of GBPs. Longitudinal studies are needed to better understand the behaviour of polyps <10 mm, that are not at a high risk of malignancy, but may change over time.
目前尚无循证指南规定不同大小的胆囊息肉（GBP）何时应进行切除。
确定能准确预测GBP恶性病变的因素；提供基于证据的管理算法。
按照PRISMA指南，使用“胆囊息肉”和“胆囊息肉样病变”等术语，对1993年1月至2013年9月期间的文献进行系统综述。纳入标准要求有组织病理学报告或2年的随访资料。使用RTI-IB工具进行质量分析。采用欧几里得距离分析GBP大小与恶性潜能的相关性；使用逻辑混合效应模型评估恶性肿瘤的独立危险因素。
共纳入53篇文献进行综述。汇总了21项研究的数据进行分析。GBP切除的最佳大小临界值为10毫米。大小<4.15毫米时恶性概率约为零。患者年龄>50岁、息肉为无蒂且单发是恶性肿瘤的独立危险因素。对于大小为4毫米至10毫米的息肉，制定了风险评估模型。
本综述和分析提供了基于证据的GBP管理算法。需要进行纵向研究，以更好地了解大小<10毫米、恶性风险不高但可能随时间变化的息肉的行为。
