Kubota K, Bandai Y, Noie T, Ishizaki Y, Teruya M, Makuuchi M
Second Department of Surgery, Faculty of Medicine, University of Tokyo, Japan.
Surgery. 1995 May;117(5):481-7. doi: 10.1016/s0039-6060(05)80245-4.
Definitive criteria for choosing the most appropriate treatment for each type of polypoid lesion of the gallbladder (PLG) have yet to be established.
The shapes, sizes, echo patterns, and echogenicities of PLGs that had been evaluated by means of ultrasonography in 72 patients who had undergone resective surgery were analyzed retrospectively to elucidate the ultrasonic characteristics of polypoid cancers and to establish criteria for selecting the most suitable treatment such as laparoscopic cholecystectomy for each type of PLG.
Histologic examinations showed cholesterol polyps in 47 patients, adenomas in 8, cancers in 16, and an inflammatory polyp in 1. The diameters of 61% of the benign PLGs were less than 10 mm, whereas those of 88% of the cancers were more than 10 mm; 80% of the former were pedunculated and 56% of the latter were sessile. Seven of eight early-stage cancers had diameters less than 18 mm, whereas those of all eight more advanced cancers were greater than 18 mm. Five of the eight early-stage cancers were pedunculated, and six of the eight more advanced cancers were sessile. Cholecystectomy with or without full-thickness dissection were main surgical procedures used to resect benign PLGs and early-stage cancers, whereas cholecystectomy with partial liver resection was used for more advanced cancers. Laparoscopic cholecystectomy was performed in the recent 34 patients, four of whom had early-stage cancers.
A PLG with a diameter of less than 18 mm is a potential early-stage cancer and therefore can be resected by laparoscopic cholecystectomy with full-thickness dissection. However, when cancer invades the subserosal layer or beyond, a second-look operation is necessary. A PLG with a diameter of greater than 18 mm may be an advanced cancer and should be removed by using cholecystectomy with partial liver resection or a more extended procedure with lymph node dissection.
针对每种类型的胆囊息肉样病变（PLG）选择最合适治疗方法的明确标准尚未确立。
回顾性分析72例行胆囊切除术患者经超声检查评估的PLG的形态、大小、回声模式及回声强度，以阐明息肉样癌的超声特征，并为每种类型的PLG制定选择最合适治疗方法（如腹腔镜胆囊切除术）的标准。
组织学检查显示，47例患者为胆固醇息肉，8例为腺瘤，16例为癌，1例为炎性息肉。61%的良性PLG直径小于10mm，而88%的癌直径大于10mm；前者80%有蒂，后者56%无蒂。8例早期癌中的7例直径小于18mm，而所有8例进展期癌直径均大于18mm。8例早期癌中的5例有蒂，8例进展期癌中的6例无蒂。切除良性PLG和早期癌的主要手术方式为胆囊切除术（有或无全层剥离），而进展期癌则采用胆囊切除联合部分肝切除术。最近34例患者行腹腔镜胆囊切除术，其中4例为早期癌。
直径小于18mm的PLG可能是早期癌，因此可通过全层剥离的腹腔镜胆囊切除术切除。然而，当癌侵犯浆膜下层或更深层时，则需要再次手术。直径大于18mm的PLG可能是进展期癌，应采用胆囊切除联合部分肝切除术或更广泛的淋巴结清扫手术切除。
