本文選題：膽囊疾病 + 息肉　； 參考：《浙江大學(xué)》2015年碩士論文

【摘要】：目的：膽囊息肉樣病變(polypoid lesion of gallbladder, PLG)是膽囊較為常見而又經(jīng)常被忽略的疾病,同時部分外科醫(yī)師對PLG的認識不足而盲目進行手術(shù)治療,給患者及社會帶來了不小負擔。目前PLG的手術(shù)指征較為混亂,本文試圖研究PLG中腫瘤性息肉的危險因素、膽囊腺瘤的臨床特點及PLG隨訪患者的特點,分析探討較為合理的手術(shù)指征及隨訪策略。 方法：回顧性分析1998年1月至2012年12月于浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院行腹部超聲發(fā)現(xiàn)PLG并入院治療的患者816例,分析其中行膽囊切除術(shù)并獲得病理結(jié)果的748例患者的臨床病理資料,并結(jié)合既往文獻分析,提出合理的膽囊息肉樣病變的處理方案。 結(jié)果：748例患者平均年齡44.49±11.62歲,息肉平均大小為9.97±4.01mm。341例有癥狀。病理報告659例為非腫瘤性息肉,68例為膽囊腺瘤,15例為膽囊癌,另有6例為慢性膽囊炎。非腫瘤性病變組息肉最大直徑平均(9.38±3.44mm)小于腫瘤性息肉組(14.55±5.71mm)(P0.01)；兩組PLG患者平均年齡(44.14±11.42歲和47.39±12.82歲)、單發(fā)性息肉比例(41.4%和59.59%)差異均具有統(tǒng)計學(xué)意義(P0.05)。膽囊腺瘤、膽囊癌患者的息肉大小(13.34±4.18mm比20.07±8.19mm)、平均年齡(45.78±11.66歲比54.13±15.82歲)差異具有統(tǒng)計學(xué)意義(P0.05),且66.7%(10/15)膽囊癌患者病理標本可見膽囊腺瘤或者異型增生細胞。對于小于10mm而進行隨訪并最終行手術(shù)明確為腫瘤性息肉的患者,其從發(fā)現(xiàn)PLG至手術(shù)的時間短于非腫瘤PLG患者(P0.05),而在息肉增大大小、息肉增大率等方面兩組差異無統(tǒng)計學(xué)意義(P0.05)。 結(jié)論：我們建議有腹部癥狀,病變最大徑大于10mm的PLG患者需要手術(shù)治療,而具有年齡大于50歲,單發(fā)息肉,合并有結(jié)石等危險因素的PLG患者在綜合考慮后可行手術(shù)治療,其余患者建議進行長期的隨訪。
[Abstract]:Objective: polypoid lesion of gallbladder (PLGs) is a common and often neglected disease of gallbladder, and some surgeons blindly operate on PLG because of their lack of understanding of PLG, which brings great burden to patients and society. At present, the surgical indications of PLG are confused. This paper attempts to study the risk factors of tumor polyps in PLG, the clinical characteristics of gallbladder adenoma and the characteristics of PLG follow-up patients, and to analyze the reasonable surgical indications and follow up strategies. Methods: from January 1998 to December 2012, 816 patients with PLG were examined by abdominal ultrasound in the second affiliated Hospital of Zhejiang University School of Medicine. The clinicopathological data of 748 patients undergoing cholecystectomy and obtaining pathological results were analyzed. Results the mean age of 748 patients was 44.49 鹵11.62 years old and the mean size of polyps was 9.97 鹵4.01mm.341. Pathological findings showed that 659 cases were nonneoplastic polyps 68 cases were gallbladder adenoma 15 cases were gallbladder carcinoma and 6 cases were chronic cholecystitis. The mean maximum diameter of polyps was 9.38 鹵3.44 mm in the non-neoplastic lesions group (P < 0.01), and the average age of the patients with PLG was 44.14 鹵11.42 years old and 47.39 鹵12.82 years old, and the proportion of single polyps was 41.4% and 59.59 mm respectively. There were significant differences between the two groups (P < 0.05), and the average age of the patients with PLG was 44.14 鹵11.42 years old and 47.39 鹵12.82 years old, and the proportion of single polyps was 41.4% and 59.59 mm respectively. The size of polyps in patients with gallbladder adenoma and gallbladder carcinoma was 13.34 鹵4.18mm vs 20.07 鹵8.19 mm, and the mean age was 45.78 鹵11.66 years vs 54.13 鹵15.82 years old. For the patients who were followed up less than 10mm and finally operated as tumor polyps, the time from the discovery of PLG to surgery was shorter than that of non-tumor PLG patients (P 0.05), but there was no significant difference between the two groups in the enlargement and size of polyps and the increase rate of polyps in the two groups (P 0.05). Conclusion: we suggest that patients with PLG with abdominal symptoms and the maximum diameter of lesion larger than 10mm should be treated surgically, while PLG patients with age over 50 years old, single polyp and complicated with stones and other risk factors should be treated surgically after comprehensive consideration. Long-term follow-up is recommended for the rest of the patients.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R735.8

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