Toda K, Souda S, Yoshikawa Y, Momiyama T, Ohshima M
Department of Surgery, Nissei Hospital, Osaka, Japan.
Surg Laparosc Endosc. 1995 Aug;5(4):267-71.
Polypoid lesions of the gallbladder taken from 103 patients were examined to correlate clinical indicators with pathological characteristics. By ultrasonographic examination, no carcinoma was found in polypoid lesions with a diameter less than 1 cm. However, the incidence of carcinoma in those with diameters greater than 1 cm was 23%, a lower rate than expected from previous pathological studies. Comparison of ultrasonographic and actual measurements suggested that the size of cholesterol polyps tended to be overestimated by ultrasonography, suggesting that the apparent risk of cancer was decreased by cholesterol polyps. Laparoscopic cholecystectomy was performed in 30 patients with polyps. No complications were encountered, and operative time was significantly shorter (p < 0.01) than in the 116 laparoscopic cholecystectomies for cholelithiasis. This study demonstrated the difficulty in distinguishing large benign polyps from carcinoma by ultrasonography. To complete the diagnosis with less invasive intervention, we propose the use of laparoscopic cholecystectomy for patients with polypoid lesions larger than 1 cm by ultrasonographic estimation.
对103例患者的胆囊息肉样病变进行检查，以将临床指标与病理特征相关联。通过超声检查，直径小于1cm的息肉样病变未发现癌变。然而，直径大于1cm的病变癌变发生率为23%，低于以往病理研究预期。超声测量与实际测量的比较表明，超声检查往往高估胆固醇息肉的大小，提示胆固醇息肉降低了表面癌症风险。对30例息肉患者实施了腹腔镜胆囊切除术。未出现并发症，手术时间显著短于（p<0.01）116例腹腔镜胆囊切除治疗胆结石的患者。本研究表明，通过超声检查难以区分大的良性息肉与癌变。为了以较少的侵入性干预完成诊断，我们建议对超声估计息肉样病变大于1cm的患者采用腹腔镜胆囊切除术。
