1.What is a gallbladder polyp?
Gallbladder polyp refers to a protruding or elevated lesion in the gallbladder cavity, which can be spherical or hemispherical, with or without a tip, and is generally benign. Since it is difficult to diagnose the nature of gallbladder polyps before surgery, they are generally called “gallbladder polyp-like lesions” or “gallbladder augmentation lesions”.
2.What types of gallbladder polyps are there?
Pathologically, they can be divided into:
(1) tumor polyp, including adenoma and adenocarcinoma, and other rare ones such as hemangioma, lipoma, smooth muscle tumor and neurofibroma.
(2) Non-neoplastic polyps, such as cholesterol polyps, inflammatory polyps, adenomatous hyperplasia, and other rare ones such as adenomatous hyperplasia, yellow granuloma, ectopic gastric mucosa or pancreatic tissue, etc.
(3) Cholesterol polyps are cholesterol crystals deposited on the mucosal surface of gallbladder; inflammatory polyps are hyperplasia of gallbladder mucosa, multiple, often less than 1 cm in diameter, mostly combined with gallbladder stones and cholecystitis; adenomatous hyperplasia of gallbladder is a hyperplastic change of gallbladder wall, such as limited type is similar to tumor, but benign.
3.What are the symptoms of gallbladder polyps?
Most of them are detected by ultrasound during physical examination and are asymptomatic. A few patients may have right upper abdominal pain, nausea and vomiting, and loss of appetite; very few cases may cause obstructive xanthogranuloma, non-stoichiometric cholecystitis, biliary bleeding, induced pancreatitis, etc. Physical examination may have pressure pain in the right upper abdomen.
4.How to diagnose gallbladder polyps?
The diagnosis of this disease mainly relies on ultrasound, but it is difficult to distinguish whether it is a tumorigenic or non-tumorigenic polyp, benign or malignant lesion. The methods to help confirm the diagnosis are: conventional ultrasound plus color Doppler ultrasound; endoscopic ultrasound; CT-enhanced scan; ultrasound-guided percutaneous fine needle aspiration biopsy. Generally speaking, color ultrasound is the most routine and practical!
5.What are the causes of gallbladder polyps?
More complex, currently more certain are: cholesterol polyps mainly because of abnormal lipid metabolism in the bile, resulting in cholesterol crystals precipitated to form polyps; chronic inflammatory stimulation of the gallbladder resulting in mucosal inflammatory hyperplasia; biliary obstruction, long-term bile stasis, concentrated bile stimulation and bacterial stimulation from the advocacy.
6.Will gallbladder polyps keep growing?
Some gallbladder polyps do not change in size in a long time, most of them will grow gradually, so they should be followed up by ultrasound regularly, and if there are indications for surgery, especially if they grow rapidly in a short time, they should be treated surgically.
7.Which gallbladder polyps need surgery?
Given that a small number of gallbladder polyps may be early-stage gallbladder cancer or may become cancerous, the following conditions are considered as risk factors for malignant lesions: diameter over 1 cm; age over 50 years; single lesion; gradually increasing polyp; combined gallbladder stones, etc.
Patients with significant symptoms should be treated surgically after excluding psychiatric factors, gastroduodenal and other biliary tract diseases.
Asymptomatic patients with the following conditions should still be considered for surgery: single lesion with a diameter of more than 1 cm, age over 50 years, enlargement on serial ultrasound, adenomatous polyp or wide base, combined gallbladder stones or gallbladder wall thickening.
8.How to follow up patients who do not need surgery for the time being?
Patients without the above conditions should not be operated urgently and should be reviewed by ultrasound every 6 months.
9.How to choose the surgery method?
For gallbladder polyps less than 2cm in diameter, laparoscopic cholecystectomy is feasible; for more than 2cm or highly suspicious of malignant change, caesarean section should be performed to facilitate radical resection.
10.How to view the “biliary surgery” for gallbladder polyps?
Gallbladder polyps aside, even in the case of cholecystitis and gallbladder stones, there are strict indications for choosing “biliary surgery”, such as: normal gallbladder function (concentration and excretion of bile) before surgery, recurrent gallbladder inflammation, no potential malignant lesions in the gallbladder, the patient is willing to have biliary surgery and can accept the related risks, especially the possibility of re-operation. In addition, in addition to normal surgical risks, biliary preservation polyp removal surgery may also occur: postoperative traumatic acute cholecystitis, polyp residual or missed, postoperative biliary leakage, biliary peritonitis, abdominal adhesions, postoperative recurrence of polyps, su thick complication of gallbladder stones, postoperative cholecystitis, etc.
Nowadays, the medical market is confusing and confusing, so I hope that patients can keep their eyes open and not be fooled by those bad hospitals that use “bile preservation” as a gimmick to solicit patients!