胆囊息肉样病变恶性倾向的临床病理分析

摘要

目的 探讨胆囊息肉样病变恶性倾向的危险因素、超声造影表现及其在鉴别良、恶性息肉样病变中的应用.方法 收集356例胆囊息肉样病变的手术病理与术前超声的资料,回顾性分析其临床和病理特征.结果 手术病理结果显示,假瘤样息肉是胆囊息肉的最主要病理类型335例(94.1％),其次为良性腺瘤和恶变息肉,分别是12例(3.4％)和9例(2.5％).在胆囊息肉恶变组中,年龄＞50岁居多(占88.9％),其息肉病理类型以乳头状或乳头管状腺瘤为主(OR=17.5,P＜0.01).随着息肉的增大,恶性率逐渐增加.息肉直径≥2 cm时,恶性率≥50.0％.结合手术病理结果分析发现,合并胆囊结石是影响胆囊息肉超声诊断的重要因素,彩色多普勒血流显像(CDFI)指标是预测良恶性息肉的独立因素.结论 年龄＞50岁、胆囊直径增大以及CDFI指标是胆囊息肉恶性倾向的危险因素.%Objective To explore potential risk factors of malignant gallbladder polypoid lesions,and evaluate the value of ultrasound in differential diagnosis of malignant and benign gallbladder polypoid lesions.Methods 356 cases of gallbladder polypoid lesions were collected and retrospectively analyzed the clinical and pathological features by data of operative pathology and preoperative ultrasonic examination.Results The operative pathological findings revealed that pseudotumor polyps were the most major pathological type (94.1％),benign adenomas and malignant polyp of gallbladder were 12 cases (3.4％) and 9 cases (2.5％) respectively.In malignant group of the gallbladder polyps,the majority (88.9％) of patients was over 50 years old,papillary or tubulopapillary adenoma was the most common polypoid lesions (OR =17.5,P ＜0.01).With the increase of the polyp size,the rate of malignancy was increased.When the polyp size was greater than or equal to 2 cm,the malignancy rate was greater than or equal to 50.0％.Preoperative ultrasonic examination revealed complicating gallstone was an important impact factor of ultrasound diagnosis of gallbladder polyps.Color Doppler flow imaging (CDFI) was an independent predictive factor for differential diagnosis of malignant and benign polyps.Conclusion More than 50 years old,increased gallbladder diameters and the CDFI are malignant potential risk factors.