摘要
目的分析采用微创保胆治疗的胆囊息肉患者的临床病理特点以及探讨0~4℃冰盐水加去甲肾上腺素冲洗胆囊黏膜的止血效果。方法回顾性分析2009年1月至2016年12月期间在新疆军区总医院行微创保胆治疗的1 008例胆囊息肉患者的临床资料,分析胆囊息肉的临床病理学类型,比较0~4℃冰盐水加不同浓度(0、16、24、30 mg/L)去甲肾上腺素冲洗胆囊黏膜的止血效果(以冲洗胆囊黏膜时间反映止血效果),同时分析手术时间与胆囊息肉复发的关系。结果本研究中1 008例胆囊息肉患者成功行保胆手术1 000例,有8例为肿瘤性息肉立即行胆囊切除术。单发息肉128例,多发息肉880例。息肉直径5~10 mm者910例,10~15 mm者98例。1 008例胆囊息肉的术后病理分析结果为胆固醇息肉912(90.5%)例、炎性息肉74(7.3%)例、腺肌增生14(1.4%)例,肿瘤性息肉8(0.8%)例[腺瘤6例,腺癌(T0N0M0)2例]。随访1~8年(平均4年),胆囊息肉复发30(3.0%)例,均为多发、胆固醇息肉。有125、230、555及98例患者分别采用0、16、24、30 mg/L浓度的去甲肾上腺素加上0~4℃冰盐水冲洗胆囊黏膜的时间分别为(44±5)min、(33±6)min、(17±5)min及(17±4)min,除24 mg/L浓度组与30 mg/L浓度组间的冲洗胆囊黏膜时间比较差异无统计学意义(P>0.05)外,其余各浓度组间的冲洗胆囊黏膜时间两两比较差异均有统计学意义(P<0.05)。970例胆囊息肉未复发者的手术时间与30例胆囊息肉复发者比较差异无统计学意义[(60±19)min比(62±21)min,P>0.05]。结论胆囊息肉的病理类型以胆固醇息肉为主,炎性息肉及肿瘤性息肉较少,以多发为主;用0~4℃冰盐水加不同浓度去甲肾上腺素对胆囊黏膜出血有一定的止血效果,以24 mg/L浓度冲洗胆囊黏膜止血效果较理想;未发现手术时间与胆囊息肉的复发有关。
Objective To analyze clinicopathologic characteristics of 1 008 patients with gallbladder polyps by minimally invasive gallbladder-preserving surgery, and to explore hemostatic effect of 0-4 ℃ cold saline plus different concentrations norepinephrines in flushing gallbladder mucosa bleeding. Methods The clinical data of 1 008 patients with gallbladder polyps by the minimally invasive gallbladder-preserving surgery from 2009 to 2016 in the General Hospital of Xinjiang Military Command were retrospectively analyzed. The clinicopathologic types of gallbladder polyps and the relationship between the operation time and the recurrence of gallbladder polyps were analyzed, the hemostatic effects of 0-4 ℃ cold saline plus different concentrations （0, 16, 24, and 30 mg/L） norepinephrines in flushing gallbladder mucosa bleeding （The hemostatic effect was reflected by the time of flushing gallbladder mucosa bleeding） were compared. Results One thousand patients with non-tumorous gallbladder polyps successfully underwent the minimally invasive gallbladder-preserving surgery, another 8 cases patients with tumorous gallbladder polyps underwent the cholecystectomy immediately. There were 128 cases of single polyps and 880 cases of multiple polyps. The polyp diameters of 910 cases were 5-10 mm and 98 cases were 10-15 mm. The pathological analysis indicated that there were 912 （90.5%） cases of the cholesterol polyps, 74 （7.3%） cases of the inflammatory polyps, 14 （1.4%） cases of the adenoid hyperplasia, and 8 （0.8%） cases of the neoplastic polyps [adenoma 6 cases, adenocarcinoma （T0N0M0） 2 cases]. The gallbladder polyps recurrences were found in 30 （3.0%） cases during 1-8 years of follow-up （average 4 years）, all of them were the multiple and cholesterol polyps. The flushing gallbladder mucosa bleeding time of 0-4 ℃ cold saline plus 0, 16, 24, and 30 mg/L concentraions norepinephrine was （44±5） min, （33±6） min, （17±5） min, and （17±4） min in the 125, 230, 555, and 98 patients with gallbladder polyps, respectively. The time of flushing gallbladder mucosa bleeding between the other concentration groups had significant difference （P〈0.05） except for between the 24 mg/L concentration group and the 30 mg/L concentration group （P〉0.05）. The operation time was （62±21） min and （60±19） min of the 30 patients with gallbladder polyps recurrence and the 970 patients without gallbladder polyps recurrence, which had no significant difference （P〉0.05）. Conclusions Cholesterol polyp is a common pathological type of gallbladder polyp, inflammatory polyp and adenomyosis polyp are uncommon, and multiple polyps are common. Hemostatic effects of 0-4 ℃ cold saline plus different concentraions norepinephrine in flushing gallbladder mucosa bleeding are desirable, expecially at a 24 mg/L concentraion norepinephrine is the most effective. No correlation is found between operation time and recurrence of gallbladder polyp.
作者
王红伟
刘江伟
康燕
林海
张嘉慧
李骜
沈才福
高伟
郑文建
李廷军
杨帆
WANG Hongwei;LIU Jiangwei;KANG Yan;LIN Hal;ZHANG Jiahui;LI Ao;SHEN Caifu;GAO Wei;ZHENG Wenjian;LI Tingjun;YANG Fan(Medical College of Shihezi University,Shihezi,Xinjiang 832000,P.R.China;Department of Hepatobiliary Surgery,General Hospital of Xinjiang Military Command,Urumqi 830000,P.R.China;Department of Ultrasonography,The No.69240 Army Hospital,Urumqi 830000,P.R.China)
出处
《中国普外基础与临床杂志》
CAS
2018年第9期1065-1070,共6页
Chinese Journal of Bases and Clinics In General Surgery
基金
新疆维吾尔自治区科技计划项目(项目编号:201042145)
军队临床高新技术重大项目(项目编号:2010gxjs016)
关键词
胆囊息肉
微创保胆术
去甲肾上腺素
止血
复发
gallbladder polyp
minimally invasive gallbladder-preserving surgery
norepinephrine
hemostasis
recurrence
