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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
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]. 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]. 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。

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.

表1 诊断良恶性PLG的单因素分析[例数(%)]
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
图2 良性PLG诊断的临床因素Nomogram图
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