Ishikawa O, Ohhigashi H, Imaoka S, Nakaizumi A, Kitamura T, Sasaki Y, Shibata T, Wada A, Iwanaga T
Department of Surgery, Center for Adult Diseases, Osaka, Japan.
Am J Gastroenterol. 1989 Nov;84(11):1386-90.
Surgically resected polypoid lesions of the gallbladder from 97 patients were evaluated to determine both the shape (pedunculated or sessile) and diameter of the polypoid lesions, in association with malignancy. At the time of analysis, the largest polypoid lesion examined was when two or more lesions were detected in one patient because they were histologically the same. Carcinoma was noted in 9 (13%) of the 67 pedunculated lesions and in 10 (33%) of the 30 sessile lesions. The sessile carcinoma was 14 +/- 4 mm (8-20 mm) in maximum diameter, which was not significantly larger than the 8 +/- 4 mm of the benign polyps, but significantly smaller than the 22 +/- 8 mm (14-35 mm) of pedunculated carcinomas (p less than 0.05). Cancer invasion extended beyond the muscular layer in eight cases (80%) of sessile carcinoma, and two of them were 10 mm or less in diameter. On the other hand, cancer invasion was beyond the muscular layer in two cases (22%) of pedunculated carcinoma (p less than 0.05), and these two were 30 mm or more in diameter. Likewise, sessile carcinoma was characterized by both a higher incidence of nodal involvement and poorer prognosis, compared with pedunculated carcinoma. These findings indicate that surgery should be undertaken when sessile polyps are detected by ultrasonography, even though the polyp may be less than 10 mm in diameter. On the other hand, with regard to the pedunculated type, malignancy should be suspected when the polyp is more than 10 mm in diameter.
对97例患者手术切除的胆囊息肉样病变进行评估，以确定息肉样病变的形状（有蒂或无蒂）和直径，并分析其与恶性肿瘤的关系。分析时，若一名患者检测到两个或更多组织学相同的病变，则以最大的息肉样病变为准。67例有蒂病变中有9例（13%）发现癌变，30例无蒂病变中有10例（33%）发现癌变。无蒂癌的最大直径为14±4毫米（8 - 20毫米），这与良性息肉的8±4毫米相比无显著差异，但明显小于有蒂癌的22±8毫米（14 - 35毫米）（p＜0.05）。8例（80%）无蒂癌的癌浸润超出肌层，其中2例直径在10毫米或以下。另一方面，2例（22%）有蒂癌的癌浸润超出肌层（p＜0.05），这2例直径在30毫米或以上。同样，与有蒂癌相比，无蒂癌的特征是淋巴结受累发生率更高，预后更差。这些发现表明，即使超声检查发现的无蒂息肉直径可能小于10毫米，也应进行手术。另一方面，对于有蒂型息肉，当直径超过10毫米时应怀疑有恶性可能。
