【摘要】：目的：鑒別膽囊息肉樣病變中與腫瘤性息肉和惡性息肉相關(guān)的危險(xiǎn)因素。 方法：對(duì)我科從2011年12月到2014年12月因膽囊息肉樣病變收治入院行腹腔鏡膽囊切除手術(shù)的329例患者的臨床病理學(xué)資料進(jìn)行回顧性研究分析。根據(jù)Christensen和Ishak提出的PLG病理分型可以將329例患者分為非腫瘤性息肉和腫瘤性息肉組。又根據(jù)手術(shù)標(biāo)本的病理結(jié)果將329例患者分為良性息肉和惡性息肉組。分別比較分析組間患者的年齡、性別、癥狀、息肉數(shù)量和大小等臨床特征。采用單因素分析和多因素Logistic回歸分析方法確認(rèn)與腫瘤性息肉和惡性息肉相關(guān)的危險(xiǎn)因素,并對(duì)相關(guān)的計(jì)量資料繪制受試者工作特征曲線(ROC曲線),找到最佳臨界值,并評(píng)估相關(guān)危險(xiǎn)因素預(yù)測(cè)的準(zhǔn)確性。 結(jié)果：?jiǎn)渭円罁?jù)影像學(xué)檢查難以區(qū)分腫瘤性和非腫瘤性息肉,以及良性息肉和惡性息肉。329例患者的基本情況如下,年齡最小為19歲,最大為77歲,平均年齡為45.5±12.3歲；男性患者135例(41%),女性患者194例(59%)；有右上腹痛等癥狀患者89例(27%),無相關(guān)癥狀患者240例(73%)；膽囊息肉單發(fā)147例(45%),多發(fā)(息肉數(shù)目有2個(gè)及2個(gè)以上)182例(55%)；膽囊息肉最大直徑平均為1.19±0.37cm。非腫瘤性息肉277例(84.2%),腺瘤43例(13.1%),癌有9例(2.7%)。采用單因素分析方法,329例患者中,與非腫瘤性息肉患者相比,腫瘤性息肉患者在息肉數(shù)量(息肉單發(fā),p=0.001)和息肉大小(大于1cm,p=0.032)等因素上的差異有統(tǒng)計(jì)學(xué)意義；與良性息肉患者相比,惡性息肉在息肉數(shù)量(息肉單發(fā),p=0.002),息肉大小(大于1.5cm,p0.001),年齡(大于50歲,p=0.007),癥狀(有相關(guān)癥狀,p=0.02)等因素上的差異有統(tǒng)計(jì)學(xué)意義。而采用多因素Logistic回歸分析方法,在腫瘤性息肉和非腫瘤性息肉組間,息肉數(shù)量(息肉單發(fā),p=0.014),息肉大小(大于1cm,p0.001),年齡(大于50歲,p=0.008)等因素上的差異有統(tǒng)計(jì)學(xué)意義；在良性腫瘤和惡性腫瘤組間,息肉大小(大于1.5cm,p=0.011)和年齡(大于50歲,p=0.004)等因素上的差異有統(tǒng)計(jì)學(xué)意義。ROC曲線表明單純用年齡和息肉大小來預(yù)測(cè)腫瘤性息肉的準(zhǔn)確性不高；而用年齡和息肉大小來預(yù)測(cè)惡性息肉均有一定的準(zhǔn)確性,最佳臨界值分別為48.5和1.515。同時(shí)為了便于臨床應(yīng)用,將其分別調(diào)整為50和1.5。 結(jié)論：PLG患者大于50歲、息肉單發(fā)且直徑大于1cm時(shí)要考慮到腫瘤性息肉的可能；當(dāng)患者大于50歲且息肉直徑超過1.5cm時(shí)要警惕惡性息肉的可能。
[Abstract]:Objective: to identify the risk factors associated with tumor polyps and malignant polyps in polypoid lesions of the gallbladder. Methods: the clinicopathological data of 329 patients with polypoid lesions of the gallbladder admitted to hospital for laparoscopic cholecystectomy from December 2011 to December 2014 were analyzed retrospectively. According to the PLG pathological classification proposed by Christensen and Ishak, 329 patients can be divided into nonneoplastic polyps and tumor polyps. According to the pathological results, 329 patients were divided into benign polyps and malignant polyps. The age, sex, symptom, number and size of polyps were compared between the two groups. Univariate analysis and multivariate Logistic regression analysis were used to identify the risk factors associated with tumor polyps and malignant polyps, and to draw the operating characteristic curve (ROC curve) for the relevant metrological data to find the best critical value. The accuracy of risk factor prediction was evaluated. Results: it was difficult to distinguish tumor polyps from non-tumor polyps, benign polyps and malignant polyps on the basis of imaging examination alone. The basic conditions of 329 patients were as follows: the minimum age was 19 years old, the maximum was 77 years old, the average age was 45.5 鹵12.3 years. 135 cases (41%) were male, 194 cases (59%) were female, 89 cases (27%) were right epigastric pain and 240 cases (73%) were no related symptoms. There were 147 cases (45%) with single gallbladder polyps and 182 cases (55%) with multiple polyps (2 or more polyps), and the mean maximum diameter of polyps was 1.19 鹵0.37 cm. There were 277 cases of nonneoplastic polyps (84.2%), 43 cases of adenoma (13.1%) and 9 cases of cancer (2.7%). Using univariate analysis, the number of polyps (single polyp, p0. 001) and the size of polyps (> 1 cm) in 329 patients with tumor polyps were compared with those of patients with nonneoplastic polyps. There were significant differences in factors such as p0. 032). Compared with patients with benign polyps, malignant polyps were found in the number of polyps (single polyp, p0. 002), polyp size (> 1. 5 cm, p0. 001), age (over 50 years, p0. 007), and symptoms (associated symptoms). There were significant differences in factors such as p0. 02). Using multivariate Logistic regression analysis, the number of polyps (single polyp, p0. 014), the size of polyps (more than 1 cm-1 p0. 001) and the age (older than 50 years) were observed in the patients with tumor polyps and non tumor polyps. There were significant differences in factors such as p0. 008). In benign and malignant tumor groups, polyp size (greater than 1.5 cm p0. 011) and age (older than 50 years), The ROC curve showed that the accuracy of age and polyp size in predicting tumor polyps was not high. However, age and polyp size have some accuracy in predicting malignant polyps, the best critical values are 48. 5 and 1. 515, respectively. In order to facilitate clinical application, it was adjusted to 50 and 1.5 respectively. Conclusion: the possibility of tumor polyps should be taken into account when PLG patients are over 50 years old and polyps are single and larger in diameter than 1cm, and the possibility of malignant polyps should be taken into account when the patients are older than 50 years and the diameter of polyps is larger than 1.5cm.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R657.4

【參考文獻(xiàn)】

相關(guān)期刊論文 前5條

1 何祖明,胡新橋,周志秀;膽囊息肉樣病變的手術(shù)指征探討[J];第一軍醫(yī)大學(xué)學(xué)報(bào);2002年10期

2 ;Diagnosis and treatment of polypoid lesions of the gallbladder:report of 194 cases[J];Hepatobiliary & Pancreatic Diseases International;2004年04期

3 王秋生，黃儦庭;膽囊息肉樣病變的特點(diǎn)與手術(shù)時(shí)機(jī)[J];中國實(shí)用外科雜志;1995年01期

4 張長樂，劉金根，，孫楊忠，徐阿曼;膽囊息肉樣病變手術(shù)指征再探討[J];普外臨床;1996年01期

5 D Chattopadhyay;R Lochan;S Balupuri;BR Gopinath;KS Wynne;;Outcome of gall bladder polypoidal lesions detected by transabdominal ultrasound scanning: A nine year experience[J];World Journal of Gastroenterology;2005年14期

本文編號(hào)：2366818