Gallbladder polypoid lesions
Introduction
Introduction to gallbladder polypoid lesions Gallbladder polypoid lesions are a general term for all non-calculus lesions that are polypoid-like in the lumen of the gallbladder wall. Gallbladder polypoid lesions can be divided into benign or malignant lesions, but non-neoplastic lesions are more common. It is generally considered that the gallbladder polypoid lesions with a diameter of 15mm or more are more likely to be malignant tumor lesions. Therefore, gallbladder polypoid lesions have received more attention in recent years. At present, the diagnosis of gallbladder polypoid lesions mainly relies on ultrasound examination. In the ultrasonography, polypoid lesions in the gallbladder cavity can be seen, which do not move with body position changes. There is no sound shadow after polypoid lesions, which can be single or multiple. Large gallbladder polypoid lesions should be tested for blood flow signals. Imaging methods can only indicate the presence of polyps and do not reveal the pathological nature of polyps. basic knowledge The proportion of sickness: 0.2% Susceptible people: no special people Mode of infection: non-infectious Complications: gallbladder cancer
Cause
Causes of gallbladder polypoid lesions
The etiology of gallbladder polypoid lesions is still unclear, but it is generally believed that the occurrence of this disease is closely related to chronic inflammation. Inflammatory polyps and adenomyosis are an inflammatory reactive disease, and cholesterol polyps are systemic fat. As a result of metabolic disorders and local inflammation of the gallbladder, it has been suggested that gallbladder polyps are associated with gallbladder inflammation or calculus, or even both.
Prevention
Prevention of gallbladder polypoid lesions
Prevention of gallbladder polypoid changes is to pay attention to the balance of diet. Eat more vegetables, coarse grains, and eat less high-cholesterol diets, so diet control and active physical exercise are the main preventive measures. In addition, regular ultrasound examinations are required. It is very important to maintain a good attitude, to maintain a good mood, to have an optimistic, open-minded spirit, and to be confident in the fight against disease. Don't be afraid, only in this way can you mobilize your subjective initiative and improve your body's immune function.
Complication
Complications of gallbladder polypoid lesions Complications gallbladder cancer
Polypoid gallbladder cancer accounts for 9% to 12%, BUS characteristics are >10mm, single hair is predominant (82%), most of them are located in the neck of the gallbladder (70%), and the lesions are mainly middle and low echoes, about 50% gallstone. In the case of the above characteristics, radical cholecystectomy should be performed early, and the connective tissue above and below the cystic duct and the fibrous adipose tissue of the gallbladder bed should be removed together.
Symptom
Gallbladder polypoid lesion symptoms Common symptoms Polyps nausea and vomiting upper abdominal discomfort right upper abdominal pain appetite decreased gallbladder stones
The most common clinically seen is the cholesterol polyps of the gallbladder, especially in young patients. Polypoid lesions seen in children under 40 years old are more common here. They are benign non-tumor lesions and will not be malignant. This occurrence is related to the disorder of cholesterol metabolism. Now, because the nutritional supplement of the Chinese people is greatly improved, the disorder of cholesterol metabolism is also obviously advanced, and the blood lipids in the blood can also be increased at the same time. Pathologically, there is a large number of mononuclear cells phagocytizing cholesterol crystals under the lamina propria of the gallbladder mucosa, which protrudes from the gallbladder mucosa and is connected with the lining of the gallbladder wall. Polyps are often multiple, mostly 3mm ~ 5mm, there is no rapid increase trend, and can fall off with bile discharge. There may also be a combination of cholecystitis, not malignant. It will also disappear with the discharge.
Multiple, less than 1cm in diameter, and the volume is not rapidly increased is a characteristic of gallbladder cholesterol polyps. Most do not require surgery, and regular ultrasound can be used. Gallbladder adenomas are most common in benign tumors of the gallbladder. Like adenomas in other organs of the digestive tract, it is potentially malignant. From the case of gallbladder resected from the hospital, the natural incidence of projection of gallbladder adenoma is about 1%. Its occurrence may be related to the long-term stimulation of gallstones and chronic inflammation. The relationship between gallbladder adenoma and gallbladder cancer may be related to the relationship between colon adenomatous polyps and colon cancer, which is the order of polyps-cancer. Histologically, it may be through adenoma-like hyperplasia adenoma cells, severe abnormal hyperplasia cancer. This view is now supported both histologically and clinically, that is, the potential malignant nature of gallbladder adenomas.
Examine
Examination of gallbladder polypoid lesions
an examination:
1, B-ultrasound
It can accurately display the size, location, number of lesions, and the condition of the capsule wall.
2, three-dimensional ultrasound imaging
It can observe the size and shape of gallbladder polyps, distinguish the relationship between polypoid lesions and gallbladder wall, and observe the continuity of lesions and the surface of the lesion through the rotation of different sections, which can help to improve the gallbladder polypoid lesions and gallbladder adenomas. Or the identification of cancer.
3, endoscopic ultrasound
Examination of the relationship between polypoid lesions and the gallbladder wall is helpful for the differential diagnosis of gallbladder polypoid lesions and gallbladder cancer.
4, CT simulation endoscopy
It can clearly show the image changes of the size, growth site, morphology, surface and base of the gallbladder polypoid lesions.
5, enhanced CT or magnetic resonance examination
The reliability of ultrasound examination is much greater than that of CT and MRI.
Diagnosis
Diagnosis and differential diagnosis of gallbladder polypoid lesions
1. Color Doppler ultrasound shows high-speed arterial blood flow signals in the mass and gallbladder wall, which is an important distinguishing feature between primary gallbladder carcinoma and benign mass and metastatic cancer. For example, the blood flow of cholesterol polyps is linear, <20cm/s; while the blood flow in gallbladder cancer is mostly dendritic, the flow rate is >20cm/s. The smaller the RI, the more prone to malignancy, but sometimes it is not sensitive to early gallbladder cancer (<3mm), and it is also related to the skill level of the operator.
2, B-guided cytology examination of gallbladder puncture, which is helpful for differential diagnosis, can improve the preoperative diagnosis rate, the positive rate of early gallbladder cancer found in bile is 64%, and the positive rate in the lesion gallbladder wall 91%. Therefore, it is emphasized that the lesion wall tissue should be selectively punctured under the guidance of B-ultrasound. Some scholars also measured the concentration of carcinoembryonic antigen (CEA) in gallbladder puncture, and compared with simple gallbladder stones, the concentration increased statistically and also has diagnostic value.
