Gallbladder polyps are also known as gallbladder augmentation lesions or gallbladder tumors. Gallbladder polyp-like lesions is a general term for all cordial non-stone lesions in which the wall of the gallbladder grows in a polyp-like pattern toward the lumen. Most of the symptoms of gallbladder polyps other similar to chronic son cholecystitis mainly agree to manifest as mild Thursday discomfort in the right upper abdomen with stones when biliary colic can occur but there are a considerable number of patients who do not move and have no symptoms to doubt just de technology in doing more than say health checkups before being found in general relatives believe that gallbladder polyps are a precipitating factor for gallbladder cancer. The disease should be treated mainly by surgery and supplemented by non-surgical treatment.
Gallbladder polyp: It is the abbreviation of various benign bulges of gallbladder mucosa. It often causes patients to delay . Currently, the main treatment for gallbladder polyps in Western medicine is surgery. However, surgical treatment is associated with complications such as vascular damage, organ damage, etc. Either complication may lead to serious consequences. In addition, it is to treat the symptoms rather than the root cause, because surgery only targets the lesion, but not the causative factors, so it cannot solve the problem at the root.
Clinical manifestations
The symptoms of most gallbladder polyps are similar to those of chronic cholecystitis, mainly manifesting as mild discomfort in the right upper abdomen and biliary colic when accompanied by stones, but there are a significant number of patients who are asymptomatic and are only detected when doing a health checkup. It is generally believed that gallbladder polyp is a predisposing factor for gallbladder cancer. In recent years, there are many reports about gallbladder polyp carcinogenesis at home and abroad, especially when accompanied with stones, the chance of carcinogenesis will be significantly increased.
Clinically, gallbladder polyps can be divided into three periods, namely: active growth period, relative stability period, absorption and dissipation period.
1, active growth period, relative stability period, absorption and dissipation period.
2.The volume of gallbladder polyps keeps increasing, does not change, and gradually decreases.
3.The number of gallbladder polyps keeps increasing, does not change, and gradually decreases.
Clinical characteristics of increasing incidence
With the diversification of human diet structure and diet rhythm and the intensification of environmental pollution, the incidence of gallbladder polyps gradually increases, such as: high cholesterol diet, long-term alcohol abuse, excessive consumption of stimulating diet, disorder of diet such as: not eating good breakfast or breakfast, too much dinner, too much and other bad eating habits, too many pesticides, food additives, ionizing radiation filled space, etc. are all related to the formation of gallbladder polyps The first feature of gallbladder polyps is their increasing incidence.
Hidden aggressiveness
Gallbladder polyps are mostly asymptomatic, and more than 85% of patients are found during routine physical examinations. On examination, polyps under 3-4 mm are difficult to detect or often missed on CT and MRI. Asymptomatic gallbladder polyps give the false impression of being painless and disease-free.
With the development of imaging, the detection rate of gallbladder polyp disease gradually increases, while doctors in non-specialized hospitals do not know or recognize this disease, or do not pay attention to it, thus creating a blind spot in the diagnosis and cognition of gallbladder polyps and a vacuum in the diagnosis and treatment, forming a wide hidden space for gallbladder polyps.
The above three points breed the hidden aggressive characteristics of gallbladder polyps.
High cancer rate
The deadly killing power of gallbladder polyps lies in sudden cancerous transformation. From the 1980s to 1990s, the cancer rate gradually increased depending on the nature of the formed gallbladder polyps. And during or after the cancerous transformation, many gallbladder polyp patients have no discomfort, unknowingly developing and unknowingly becoming cancerous, which is the most frightening feature of gallbladder polyps.
Treatment
Gallbladder polyp lesions are not uncommon clinically, and surgery is the radical cure, but not all gallbladder polyps require surgical treatment. Because of the different types of lesions, different sizes, and different disease regression, the indications for surgery are not consistent.
Timing of surgery: Gallbladder polyp-like lesions are sometimes difficult to characterize preoperatively. We propose the following surgical indications according to the high-risk factors for malignant transformation of gallbladder polyp-like lesions.
1.Single lesion, larger than 10 mm, with a thick tip, especially if located in the neck of the gallbladder and older than 50 years of age.
2.Multiple lesions with gallbladder stones, symptomatic, age > 50 years.
3.Single lesion, less than 10mm, asymptomatic, age less than 50 years old, allowed to observe and follow up; lesion enlargement or morphological changes should be treated surgically.
4.Doppler ultrasound examination of the lesion with rich blood supply suggests malignant neoplasm.
5, CEA (tumor marker), the measured value is significantly elevated and except for other gastrointestinal tumors.
6.Gallbladder polyp-like lesions with obvious symptoms and recurrence.
7.Asymptomatic patients with diameter less than 5 mm should be followed up at intervals of 3 to 5 months. Once the lesion is enlarged or the symptoms are obvious, surgical treatment should be performed.
In recent years, non-surgical and herbal treatment of gallbladder polyp disease has attracted widespread attention in the medical community, a variety of prescriptions, formulas, test prescriptions, etc. in anti-inflammatory, biliary, control of cholecystitis, gallbladder polyps, etc. have achieved certain results, for the gallbladder polyps of specialist drugs have also made great achievements, with the in-depth study of Chinese medicine, non-surgical treatment of gallbladder polyps cure rate, is also rapidly increasing.
The historical process of gallbladder polyp treatment Stage 1: Cholecystectomy
This is the main method currently adopted by some hospitals, the reason being that when the gallbladder polyp is greater than or equal to 1cm, the polyp is likely to become malignant. In fact, there are two major misconceptions here, one is that we do not see what type of polyps are; and the other is that there is no pathological laboratory evidence. The only evidence is the preoperative ultrasound examination, however, neither the actual sight nor the pathological results are available. Therefore, the conclusion was that malignancy was “probable”. In terms of evidence-based medicine, the evidence for biliary excision was insufficient.
Stage 2: Minimally invasive fiberoptic choledochoscopy for biliary polyp removal
This is a major breakthrough in the treatment of gallbladder polyps, from what is seen under ultrasound to what is seen directly by choledochoscopy, with a magnification of more than 6 times, just like gastroscopy and colonoscopy. There are three types of common gallbladder polyps, cholesterol polyps, inflammatory polyps and verrucous polyps. The first two types are benign and the latter one is malignant in about 10-15%, so intraoperative pathology becomes an important basis for diagnosing benign and malignant polyps; therefore, cholangioscopy plus pathology is the gold standard for polyp diagnosis. However, the disadvantage is that the bending of the fiberoptic cholangioscope makes it more difficult to deal with some small polyps, such as small polyps of 1 to 2 mm in the neck of the gallbladder, which are limited by this method. If the polyps are diagnosed as malignant intraoperatively, radical surgery for gallbladder cancer is performed.
Stage 3: biliary scleroscopy for polypectomy
The application of this technology is another major breakthrough, because the biliary mirror used is changed from soft mirror to hard (straight) mirror, which can remove 0.1mm polyps, making the treatment of gallbladder polyps to a new level and solving the problems that cannot be solved by fiber choledochoscope.
Do I have to have surgery for gallbladder polyps?
If the fruit is a polyp caused by chronic inflammation, called inflammatory polyps, and polyps related to the gallbladder, if it is an inflammatory polyp, if it is this aspect of the patient can be treated by medication, the combination of Chinese and Western medicine is very good. The combination of Chinese and Western medicine is very good. The treatment of gallbladder polyps can be treated by medication at the same time, or at least delay the recurrence and further development of gallbladder polyps.
If the polyp is tumorigenic and has inflammatory stimulation, the dual effect is to check for certain cancer, which usually grows larger in a short period of time or is larger than one centimeter in diameter, then removal of the gallbladder is recommended to prevent it from developing into gallbladder cancer. Recently, there are some techniques to remove polyps from the gallbladder wall simply by using laparoscopic techniques, using a small endoscopic opening to penetrate into the gallbladder wall, but not all gallbladder walls can be removed, only polyps with a tip can be done.
In the laparoscopic approach, four small incisions are made in the patient’s abdominal wall and then puncture instruments are inserted. The laparoscope, which is placed through the belly button, can be observed at a glance and allows for a good removal work. If operated by an experienced surgeon, it is less invasive and] recovery is quick.
Minimally invasive bile preservation for polyp removal
There is no specific standard for gallbladder polyp surgery. Some people are afraid of cancerous polyps and think that as long as polyps are found, they should be operated, which is not true, generally most of gallbladder polyps are cholesterol polyps and rarely become cancerous, so there is no need to be nervous. It is generally believed that 1cm is the approximate limit, but more attention is paid to the trend of enlargement. 1cm or less is closely observed. To decide whether to remove the gallbladder, the main thing is to send the pathology immediately during the operation, if it is malignant, the gallbladder will be removed, and vice versa, the gallbladder will be preserved. At present, endoscopic biliary polypectomy is a new concept of high-tech new technology, which is the most scientific method at present.
A. Surgical indications for gallbladder polyp preservation and stone removal surgery
1.By ultrasound or other imaging examination, it is confirmed that the diameter of gallbladder polyps is greater than 8mm or multiple polyps of gallbladder.
2, by te99ect or oral cholecystography gallbladder imaging, the gallbladder function is normal.
3.Though te99ect or oral cholecystography gallbladder does not appear, but intraoperative confirmation of gallbladder duct patency.
4, combined with gallbladder stones refer to gallbladder stones treatment.
Second, the gallbladder polyps biliary surgery contraindications
1, intraoperative pathology confirmed that the polyps are malignant.
2.The polyps are wide based and cannot be removed.
3, polyps after excision of trauma bleeding, hemostasis is ineffective.
”Biliary polyp removal surgery” is a kind of minimally invasive surgery, which is a product of the combination of modern high-tech and traditional surgical techniques. It avoids all kinds of damage and discomfort caused by the traditional open surgical incision. Biliary polyp removal surgery is a one-time removal of polyps to protect the body’s bile storage site while preserving the healthy gallbladder for patients with biliary polyps. The polyps can be easily removed through a 0.5-2 cm skin incision without the need for open surgery. The procedure is visualized, safe, quick and not easy to recur after surgery. The postoperative recovery is fast and minimally invasive, and you can move around and eat on the ground 1 day after surgery, and you can be discharged after 3-5 days of hospitalization, which does not affect your normal work and life, and also reduces the cost of treatment. Since it is a minimally invasive surgery, the operation time is short, bleeding is less, pain is less, and patients themselves can see the whole surgical treatment process and results.