切换至 "中华医学电子期刊资源库"
高级检索
中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2021, Vol. 10 ›› Issue (02) : 147 -152. doi: 10.3877/cma.j.issn.2095-3232.2021.02.007

所属专题： 经典病例； 文献；

临床研究

胆囊息肉样病变手术指征再思考——388例胆囊切除术回顾性研究
刘凯1, 卢逸2, 木斯他巴·买买提热依木3, 窦宁馨4, 许明星2, 林楠2, 许瑞云2,†()   
  1. 1. 518000　深圳，中山大学附属第七医院普通外科
    2. 510630　广州，中山大学附属第三医院肝胆外科
    3. 844000　新疆维吾尔自治区喀什地区第一人民医院普外一科
    4. 510275　广州，中山大学中山医学院
  • 收稿日期:2020-12-25 出版日期:2021-04-10
  • 通信作者: 许瑞云

Rediscussion of surgical indications for gallbladder polypoid lesions: a retrospective study of 388 cases of cholecystectomy

Kai Liu1, Yi Lu2, Maimaitireyimu Musitaba·3, Ningxin Dou4, Mingxing Xu2, Nan Lin2, Ruiyun Xu2,†()   

  1. 1. Department of General Surgery, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518000, China
    2. Department of Hepatobiliary Surgery, the Third Affiliated Hospital of Sun Yat-senUniversity, Guangzhou 510630, China
    3. Department Ⅰ of General Surgery, the First People's Hospital of Kashgar Prefecture, Kashgar 844000, China
    4. Sun Yat-sen University Zhongshan School of Medicine, Guangzhou 510275, China
  • Received:2020-12-25 Published:2021-04-10
  • Corresponding author: Ruiyun Xu
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

刘凯, 卢逸, 木斯他巴·买买提热依木, 窦宁馨, 许明星, 林楠, 许瑞云. 胆囊息肉样病变手术指征再思考——388例胆囊切除术回顾性研究[J/OL]. 中华肝脏外科手术学电子杂志, 2021, 10(02): 147-152.

Kai Liu, Yi Lu, Maimaitireyimu Musitaba·, Ningxin Dou, Mingxing Xu, Nan Lin, Ruiyun Xu. Rediscussion of surgical indications for gallbladder polypoid lesions: a retrospective study of 388 cases of cholecystectomy[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(02): 147-152.

目的

探讨胆囊息肉样病变（PLG）手术指征。

方法

回顾性分析2008年1月至2018年12月在中山大学附属第三医院行胆囊切除术的388例PLG患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男212例，女176例；年龄18～80岁，中位年龄41岁。采用ROC曲线确定良恶性病变的最佳预测界值，Logistic回归分析确定PLG恶变的危险因素，绘制Nomogram图预测良性病变发生概率。

结果

ROC曲线显示，术前彩超提示直径12.0 mm为良性PLG诊断的最佳界值，14.5 mm为恶性PLG诊断的最佳界值。Logistic回归多因素分析显示，术前彩超提示直径<12 mm、数目多发、无血流、不合并胆囊结石是良性PLG的独立影响因素（OR=2.341，2.179，2.159，2.195；P<0.05）；术前彩超提示直径≥ 12 mm和血胆固醇异常是恶性PLG的独立影响因素（OR=9.642，2.601；P<0.05）。绘制诊断良性PLG的临床因素Nomogram图，结果显示PLG直径权重最大，直径<12 mm良性病变可能性大。

结论

胆囊息肉直径≥ 12 mm可能是胆囊息肉患者胆囊切除的最佳指征，其可以在保证恶变漏诊率较低的同时避免不必要的胆囊切除，为患者和社会节约医疗资源。

关键词: 胆囊, 息肉, 胆囊切除术, 预测
Objective

To investigate the surgical indications for polypoid lesions of the gallbladder (PLG).

Methods

Clinical data of 388 patients with PLG undergoing cholecystectomy in the Third Affiliated Hospital of Sun Yat-sen University from January 2008 to December 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 212 patients were male and 176 female, aged from 18 to 80 years, with a median age of 41 years. The optimal threshold value for the diagnosis of benign or malignant lesions was determined by ROC curve. The risk factors for PLG malignancy were identified by Logistic regression analysis. Nomogram was delineated to predict the probability of benign lesions.

Results

The ROC curve showed that a diameter 12.0 mm was the optimal threshold value for the diagnosis of benign PLG and 14.5 mm for the diagnosis of malignant PLG. Logistic multivariate regression analysis revealed that, a diameter <12 mm, multiple lesions, no blood flow and no gallstones detected by preoperative color Doppler ultrasound were the independent influencing factors for benign PLG (OR=2.341, 2.179, 2.159, 2.195; P<0.05). Preoperative color Doppler ultrasound indicated that a diameter ≥12 mm and abnormal blood cholesterol were the independent influencing factors for malignant PLG (OR=9.642, 2.601; P<0.05). The Nomogram of clinical factors for the diagnosis of benign PLG was delineated. The results showed that PLG diameter occupied the greatest weight, anda diameter <12 mm predicted the possibility of benign lesions.

Conclusions

The diameter ≥12 mm may be the optimal surgical indication for cholecystectomy in patients with PLG, which can avoid unnecessary cholecystectomy while ensuring a low misdiagnosis rate of malignant PLG and minimize medical expenses for the patients and society.

Key words: Gallbladder, Polyps, Cholecystectomy, Forecasting
表1 诊断良恶性PLG的单因素分析[例数(%)]
因素 例数 良性PLG 恶性PLG
良性组 非良性组 χ2值 P值 恶性组 非恶性组 χ2值 P值
临床症状 212 152（56） 60（52） 0.625 0.429 10（35） 202（56） 5.214 0.022
PLG数目单发 147 80（29） 67（58） 26.917 <0.001 20（69） 127（35） 12.228 <0.001
有血流 190 109（40） 81（70） 9.450 0.002 26（90） 164（46） 5.671 0.017
TB异常 33 29（11） 4（3） 5.387 0.020 32（9） 1（4） 0.393 0.530
GGT异常 56 47（17） 9（8） 5.896 0.015 51（14） 5（18） 0.060 0.807
TG异常 82 67（25） 15（13） 7.253 0.007 77（23） 5（18） 0.334 0.563
HDL-C异常 108 84（31） 24（21） 4.774 0.029 102（30） 6（21） 0.900 0.343
图1 良恶性PLG直径诊断最佳界值的ROC曲线
表2 良恶性PLG危险因素Logistic回归多因素分析
因素 良性PLG 恶性PLG
OR 95%CI P值 OR 95%CI P值
直径<12 mm 2.341 1.316～4.166 0.004 - - -
直径≥12 mm - - - 9.642 3.141～29.599 <0.001
TC异常 0.596 0.204～1.743 0.345 2.601 1.068～6.334 0.035
数目多发 2.179 1.228～3.865 0.008 0.592 0.217～1.613 0.306
无血流 2.159 1.072～4.346 0.031 0.301 0.062～1.462 0.137
不合并胆囊结石 2.195 1.109～4.344 0.024 0.676 0.246～1.860 0.448
图2 良性PLG诊断的临床因素Nomogram图
[1]
Park KW, Kim SH, Choi SH, et al. Differentiation of nonneoplastic and neoplastic gallbladder polyps 1 cm or bigger with multi-detector row computed tomography[J]. J Comput Assist Tomogr, 2010, 34(1):135-139.
[2]
McCain RS, Diamond A, Jones C, et al. Current practices and future prospects for the management of gallbladder polyps: a topical review[J]. World J Gastroenterol, 2018, 24(26):2844-2852.
[3]
Lee YJ, Park KS, Cho KB, et al. Shifting prevalence of gallbladder polyps in Korea[J]. J Korean Med Sci, 2014, 29(9):1247-1252.
[4]
Mao YS, Mai YF, Li FJ, et al. Prevalence and risk factors of gallbladder polypoid lesions in Chinese petrochemical employees[J]. World J Gastroenterol, 2013, 19(27):4393-4399.
[5]
Wiles R, Thoeni RF, Barbu ST, et al. Management and follow-up of gallbladder polyps: joint guidelines between the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Association for Endoscopic Surgery and other Interventional Techniques (EAES), International Society of Digestive Surgery-European Federation (EFISDS) and European Society of Gastrointestinal Endoscopy (ESGE)[J]. Eur Radiol, 2017, 27(9): 3856-3866.
[6]
Lee SR, Kim HO, Shin JH. Reasonable cholecystectomy of gallbladder polyp-10 years of experience[J]. Asian J Surg, 2019, 42(1):332-337.
[7]
Hu MT, Wang JH, Yu Y, et al. Tumor suppressor LKB1 inhibits the progression of gallbladder carcinoma and predicts the prognosis of patients with this malignancy[J]. Int J Oncol, 2018, 53(3):1215-1226.
[8]
Bubnova MG, Kukharchuk VV. Recommendations of the European Society of Cardiology and the European Atherosclerosis Society on cardiovascular disease prevention and management of dyslipidemias. for the diagnosis of atherosclerosis and dyslipidemia treatment (2016): basic S.G.[J]. Kardiologiia, 2017, 57(3):85-89.
[9]
Christensen AH, Ishak KG. Benign tumors and pseudotumors of the gallbladder. report of 180 cases[J]. Arch Pathol, 1970, 90(5):423-432.
[10]
Xu A, Zhang Y, Hu H, et al. Gallbladder polypoid-lesions: what are they and how should they be treated? a single-center experience based on 1 446 cholecystectomy patients[J]. J Gastrointest Surg, 2017, 21(11):1804-1812.
[11]
Xu A, Hu H. The gallbladder polypoid-lesions conundrum: moving forward with controversy by looking back[J]. Expert Rev Gastroenterol Hepatol, 2017, 11(11):1071-1080.
[12]
Prokop LD. Isotretinoin: possible component cause of inflammatory bowel disease[J]. Am J Gastroenterol, 1999, 94(9):2568.
[13]
Akiyama T, Sahara H, Seto K, et al. Gallbladder cancer associated with cholesterosis[J]. J Gastroenterol, 1996, 31(3):470-474.
[14]
Choi YS, Do JH, Seo SW, et al. Prevalence and risk factors of gallbladder polypoid lesions in a healthy population[J]. Yonsei Med J, 2016, 57(6):1370-1375.
[15]
Yang HL, Kong L, Hou LL, et al. Analysis of risk factors for polypoid lesions of gallbladder among health examinees[J]. World J Gastroenterol, 2012, 18(23):3015-3019.
[16]
赵刚，吴志勇. 胆囊癌癌前病变的新认识与处理原则[J]. 中国实用外科杂志，2011(3)：198-202.
[17]
Adsay NV. Neoplastic precursors of the gallbladder and extrahepatic biliary system[J]. Gastroenterol Clin North Am, 2007, 36(4):889-900, vii.
[18]
Sasatomi E, Tokunaga O, Miyazaki K. Precancerous conditions of gallbladder carcinoma: overview of histopathologic characteristics and molecular genetic findings[J]. J Hepatobiliary Pancreat Surg, 2000, 7(6):556-567.
[19]
伍英，熊环，何睿，等. 广州市某三级甲等医院2005年-2014年原发性胆囊癌手术患者住院情况分析[J]. 中国病案，2015，16(9)：72-75.
[20]
Limberg J, Ullmann TM, Gray KD, et al. Laparoscopic adrenalectomy has the same operative risk as routine laparoscopic cholecystectomy[J]. J Surg Res, 2019(241):228-234.
[1] 奚玲, 仝瀚文, 缪骥, 毛永欢, 沈晓菲, 杜峻峰, 刘晔. 基于肌少症构建的造口旁疝危险因素预测模型[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 48-51.
[2] 杨建波, 马欢, 黄小梅, 刘华柱. 结肠镜辅助下EMR、CSP和RFA术治疗直径＜1cm结直肠息肉的疗效和安全性比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 76-79.
[3] 王兴, 文阳辉, 姚戈冰, 郭平学, 杨自华. ICG荧光腹腔镜下胆囊切除术的临床应用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 663-666.
[4] 康婵娟, 张海涛, 翟静洁. 胰管支架置入术治疗急性胆源性胰腺炎的效果及对患者肝功能、炎症因子水平的影响[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 667-670.
[5] 屈勤芳, 束方莲. 盆腔器官脱垂患者盆底重建手术后压力性尿失禁发生的影响因素及列线图预测模型构建[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 606-612.
[6] 王秋生. 胆道良性疾病诊疗策略[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 779-782.
[7] 周迪, 全志伟. 规范化胆囊良性疾病诊治流程减少胆囊癌误诊误治[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 749-753.
[8] 陈伟杰, 何小东. 胆囊癌免疫靶向治疗进展[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 763-768.
[9] 郑大雯, 王健东. 胆囊癌辅助诊断研究进展[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 769-773.
[10] 林科灿, 罗柳平. 肝胰十二指肠切除术在胆囊癌和胆管癌应用中的关键问题[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 774-778.
[11] 孙晗, 于冰, 武侠, 周熙朗. 基于循环肿瘤DNA 甲基化的结直肠癌筛查预测模型的构建与验证[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 500-506.
[12] 丁富贵, 吴泽涛, 董卫国. 家族性腺瘤性息肉病临床特征及生物信息学分析[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 512-518.
[13] 韦巧玲, 黄妍, 赵昌, 宋庆峰, 陈祖毅, 黄莹, 蒙嫦, 黄靖. 肝癌微波消融术后中重度疼痛风险预测列线图模型构建及验证[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 715-721.
[14] 蔡晓雯, 李慧景, 丘婕, 杨翼帆, 吴素贤, 林玉彤, 何秋娜. 肝癌患者肝动脉化疗栓塞术后疼痛风险预测模型的构建及验证[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 722-728.
[15] 王誉英, 刘世伟, 王睿, 曾娅玲, 涂禧慧, 张蒲蓉. 老年乳腺癌新辅助治疗病理完全缓解的预测因素分析[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 641-646.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号