Is it necessary to perform prophylactic cholecystectomy for asymptomatic subjects with gallbladder polyps and gallstones?
Is it necessary to perform prophylactic cholecystectomy for asymptomatic subjects with gallbladder polyps and gallstones?
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DOI：
10.1111/j.1440-1746.2010.06288.x
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发表时间：
2010-06-01
影响因子：
4.1
通讯作者：
Kim, Byung Ik
中科院分区：
文献类型：
--
作者：
Choi, Sung Youn;Kim, Tae Sun;Kim, Byung Ik
背景和目的：本研究的目的是确定胆囊息肉和胆石症患者与单纯胆囊息肉患者的临床特征。方法：在1999年8月至2005年12月期间，招募了176例胆囊息肉和胆石症患者（研究组），并与185例单纯胆囊息肉患者（对照组）进行了比较。结果：随访期间，研究组和对照组之间息肉大小的平均间隔变化（Δ）无显著差异（分别为0.85 +/- 1.39 mm vs 0.84 +/- 1.58 mm，P = 0.927）。研究组急性胆囊炎发生率（9/176 [5.1%]）明显高于对照组（1/185 [0.5%]，P < 0.01）。经多因素Logistic回归分析，首次超声检查胆囊壁增厚（比值比，13.7; 95%置信区间，1.1-178.0; P = 0.046）和胆囊息肉大小的间隔增加（比值比，14.7; 95%可信区间，1.7-126.9; P = 0.014）是胆囊切除术的独立危险因素。结论：胆囊息肉合并胆石症患者与单纯胆囊息肉患者的Delta息肉大小无显著性差异。因此，一小部分患有胆囊息肉和胆石症的受试者，如胆囊壁增厚和胆囊息肉大小间隔增加的受试者，是预防性胆囊切除术的候选者。
Background and Aims:The purpose of the present study was to determine the clinical characteristics of subjects with gallbladder polyps and cholelithiasis compared with those with gallbladder polyps only.Methods:Between August 1999 and December 2005, 176 subjects with gallbladder polyps and cholelithiasis (study group) by transabdominal ultrasonography performed during a medical check-up at our institution were recruited and compared with a control group of 185 subjects who had gallbladder polyps only.Results:No significant difference in the mean interval change (delta) of polyp size during the follow-up period between the study and control groups (0.85 +/- 1.39 mm vs 0.84 +/- 1.58 mm, respectively, P = 0.927) was noted. A significantly higher proportion (9/176 [5.1%]) of examinees in the study group had attacks of acute cholecystitis compared with the control group (1/185 [0.5%], P < 0.01). By multivariate logistic regression analysis, gallbladder wall thickening on initial ultrasonography (odds ratio, 13.7; 95% confidence interval, 1.1-178.0; P = 0.046) and the interval increase in the size of the gallbladder polyps (odds ratio, 14.7; 95% confidence interval, 1.7-126.9; P = 0.014) were independent risk factors for cholecystectomy. No gallbladder cancer occurred during the follow-up period.Conclusions:There was no significant difference in delta polyp size between the examinees with gallbladder polyps and cholelithiasis and those with gallbladder polyps only. Hence, a small proportion of subjects with gallbladder polyps and cholelithiasis, such as those with thickened gallbladder walls and an interval increase in the size of the gallbladder polyps are candidates for prophylactic cholecytectomy.