胆囊息肉病的治疗策略:一项5年单中心队列研究的结果。

IF 1.8 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Digestive Surgery Pub Date : 2022-01-01 DOI:10.1159/000529221
Feng Tian, Yu-Xin Ma, Yi-Fan Liu, Wei Liu, Tao Hong, Xiao-Dong He, Qiang Qu
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引用次数: 0

摘要

导言:胆囊息肉样病变(GPLs)的分类、鉴别诊断和治疗策略仍有争议。本研究旨在探讨gpl的个体化治疗策略。方法:我们回顾性研究了2015年1月至2020年5月连续642例GPLs患者。通过单因素和多因素分析探讨肿瘤性息肉的潜在危险因素。评价腹腔镜保胆息肉切除术(GPP)与腹腔镜胆囊切除术(LC)的疗效。结果:642例入组患者中,572例行LC, 70例行GPP。病理上以胆固醇息肉为主(68.4%),其次为腺肌瘤病(19.9%)、良性腺瘤(7.3%)、腺癌(3.6%)和罕见病理类型(0.8%)。66.3%(379/572)的LC病例为非肿瘤性息肉,33.7%(193/572)为肿瘤性息肉。多因素分析显示单个息肉(OR 1.956, 95% CI: 1.121-3.412;p = 0.018),胆囊底息肉(OR 4.326, 95% CI: 2.179-8.591;p < 0.001),息肉不小于14 mm (OR 2.833, 95% CI: 1.614-4.973;p < 0.001),息肉基底较宽(OR 4.173, 95% CI: 1.743-9.990;P = 0.001)是肿瘤性息肉的独立危险因素。GPP术后5年前瞻性结果显示,1年和3年息肉复发率分别为13.2%和23.4%。结论:gpl多为胆固醇或其他良性病变,无恶性潜能。LC是具有高肿瘤风险的gpl的主要治疗方法。GPP具有潜在的可行性,对于符合选择标准的一组GPLs患者,GPP可能是一种替代的管理策略。
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Management Strategy for Gallbladder Polypoid Lesions: Results of a 5-Year Single-Center Cohort Study.

Introduction: Controversy remains about the classification, differential diagnosis, and treatment strategy for gallbladder polypoid lesions (GPLs). This study sought to explore the individualized treatment strategy for GPLs.

Methods: We retrospectively studied 642 consecutive patients with GPLs from January 2015 to May 2020. Univariate and multivariable analyses were performed to explore the potential risk factors for neoplastic polyps. The outcome of laparoscopic gallbladder-preserving polypectomy (GPP) was evaluated and compared with that of laparoscopic cholecystectomy (LC).

Results: Of 642 enrolled patients, 572 underwent LC, and 70 underwent GPP. Pathologically, the majority of GPLs were cholesterol polyps (68.4%), followed by adenomyomatosis (19.9%), benign adenoma (7.3%), adenocarcinoma (3.6%), and rare pathological types (0.8%). Additionally, 66.3% (379/572) of the LC cases were classified as non-neoplastic, and 33.7% (193/572) neoplastic polyps. Multivariate analysis demonstrated that single polyps (OR 1.956, 95% CI: 1.121-3.412; p = 0.018), polyps located at the gallbladder fundus (OR 4.326, 95% CI: 2.179-8.591; p < 0.001), polyps not less than 14 mm (OR 2.833, 95% CI: 1.614-4.973; p < 0.001), and polyps with a broad base (OR 4.173, 95% CI: 1.743-9.990; p = 0.001) were independent risk factors for neoplastic polyps. The 5-year prospective results after GPP showed that the 1-year and 3-year polyp recurrence rates were 13.2% and 23.4%, respectively.

Conclusion: The majority of GPLs are cholesterol or other benign lesions without malignant potential. LC is the main treatment procedure for GPLs with a high neoplastic risk. GPP is potentially feasible and could be an alternative management strategy for a group of GPLs patients who meet the selection criteria.

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来源期刊
Digestive Surgery
Digestive Surgery 医学-外科
CiteScore
4.90
自引率
3.70%
发文量
25
审稿时长
3 months
期刊介绍: ''Digestive Surgery'' presents a comprehensive overview in the field of gastrointestinal surgery. Interdisciplinary in scope, the journal keeps the specialist aware of advances in all fields that contribute to improvements in the diagnosis and treatment of gastrointestinal disease. Particular emphasis is given to articles that evaluate not only recent clinical developments, especially clinical trials and technical innovations such as new endoscopic and laparoscopic procedures, but also relevant translational research. Each contribution is carefully aligned with the need of the digestive surgeon. Thus, the journal is an important component of the continuing medical education of surgeons who want their practice to benefit from a familiarity with new knowledge in all its dimensions.
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