背景:胆囊息肉的发病率为0.3-12%。区分假性息肉(胆固醇息肉,子宫腺瘤病,炎症性息肉),没有能力变得恶性,来自真正的息肉(腺瘤和腺癌)。恶性肿瘤的主要危险因素是>6-10毫米,增长,固着形态,印度种族和原发性硬化性胆管炎。超声是诊断的金标准。超声诊断的大多数息肉是假息肉。这项研究的主要目的是分析超声检查是否准确诊断手术患者的真实息肉。
方法:回顾性观察性研究,对2007年至2021年因胆囊息肉接受择期胆囊切除术的患者进行前瞻性数据输入。对有症状的患者和有危险因素的患者进行手术。该研究已获得我院临床研究伦理委员会的批准。
结果:我们纳入了124例患者。所有患者均进行了选择性腹腔镜胆囊切除术。平均年龄为55,4岁,61%为女性。在所有患者中,65%在诊断时出现症状。只有3例患者有真正的息肉(2,4%)。均为管状腺瘤。其余患者为假阳性(97,6%)。腺瘤大小为11、6和5毫米,分别。手术指征是由于息肉大小或相关的胆道症状。
结论:超声检查对胆囊息肉的诊断并不准确。对无症状患者的胆囊息肉的诊断进行其他补充测试的验证可能与避免不必要的手术有关。
BACKGROUND: Incidence of gallbladder
polyps is 0,3-12%. It is important to differentiate pseudopolyps (cholesterol
polyps, adenomyomatosis, inflammatory
polyps), which do not have the capacity to become malignant, from true
polyps (adenomas and adenocarcinomas). The main risk factors for malignancy are >6-10 mm, growth, sessile morphology, Indian ethnicity and primary sclerosing cholangitis. Ultrasound is the gold standard for diagnosis. Most
polyps diagnosed by ultrasound are pseudopolyps. The main objective of this study is to analyse whether ultrasound is accurate for diagnosing true polyps in patients undergoing surgery for this reason.
METHODS: Retrospective observational study with prospective data entry of patients undergoing elective cholecystectomy for gallbladder polyps from 2007 to 2021. Surgery was indicated in symptomatic patients and in those with risk factors. The study has been approved by the Clinical Research Ethics Committee of our hospital.
RESULTS: We included 124 patients in our study. An elective laparoscopic cholecystectomy was performed in all of them. The mean age was 55,4 years and 61% were women. Of all patients, 65% were symptomatic at diagnosis. Only 3 patients had true
polyps (2,4%). All of them were tubular adenomas. The rest of patients were false positives (97,6%). The adenoma size was 11, 6 and 5 mm, respectively. The surgical indication was due to polyp size or due to associated biliary symptoms.
CONCLUSIONS: Ultrasonography is not accurate for the diagnosis of gallbladder polyps. Validation of other complementary tests for the diagnosis of gallbladder polyps in asymptomatic patients could be relevant to avoid unnecessary surgeries.