Gallbladder polyps are also known as: gallbladder bulge-like lesions (PLG). Gallbladder polyp-like lesions are clinically simplified into three main categories to differentiate the different types of gallbladder polyps. It helps patients and non-specialists to make judgments.
Category I: cholesterol polyps.
It accounts for 1/2 of the total number and no cancer has been reported so far, so doctors also call it pseudopolyps. It is mulberry-shaped in appearance, brittle and fragile, easy to fall off, mostly within 1,0cm, mainly multiple, and located in the body of the gallbladder. Most patients with cholesterol polyps have no symptoms or mild symptoms, and the gallbladder functions well, so they can be reviewed by ultrasound regularly every 3-6 months to observe the size change. Surgery should be considered only if there are significant symptoms. For good gallbladder function and no acute and chronic inflammation of the gallbladder can be preferred to choledochoscopy, laparoscopy combined with gallbladder endoscopy, biopsy and treatment (also called minimally invasive endoscopic biliary polyp removal biopsy), if the gallbladder function is poor, or with acute and chronic inflammation can be preferred to laparoscopic cholecystectomy.
Category 2: Benign non-cholesterol polyps.
They account for 2/5 of the total number and mainly refer to: gallbladder adenoma, adenomyoma, inflammatory polyp, and adenomatous hyperplasia, of which adenoma is a recognized precancerous lesion with a cancer rate of about 10%, and adenomyosis also has a potential cancer risk. Therefore, these lesions should be surgically removed or prophylactic cholecystectomy should be performed, and laparoscopic cholecystectomy is preferred.
The third category: polyp type early gallbladder cancer.
It accounts for about 10%. At present, for polyp-type early gallbladder cancer mixed with gallbladder polyps, we mainly rely on ultrasound to detect them. Ultrasound features are: greater than 10 mm (88%); solitary (82%); mostly located in the neck of gallbladder (70%); about 50% are accompanied by gallbladder stones; the echogenic intensity of the lesion is mainly low to medium echogenicity. Once such lesions are suspected, radical cholecystectomy should be performed as soon as possible.
Each of these three types of lesions has its own characteristics and corresponding treatment plan, and doctors and patients can differentiate them according to these characteristics.
Gallbladder polyps and gallbladder cancer: According to the domestic health checkup statistics, 5% of the normal population has PLG detected. In other words, 5% of people can detect gallbladder polyps in routine physical examinations organized by various organizations, and clinical statistics show that 82% of patients with gallbladder polyps are non-neoplastic lesions. From the above classification, we can see that only about 10% of polyps can definitely turn into cancer. Another 40% of benign non-cholesterol polyps such as adenoma, adenomyoma, and adenomyosis, of which adenoma is a recognized precancerous lesion with a cancer rate of about 10%, and adenomyosis also has a potential risk of cancer.
However, in China, 9% of 1620 cases with pathologically confirmed gallbladder polyps are gallbladder polypoid carcinoma, while the better surgical efficacy of gallbladder cancer is limited to early stage, and the overall surgical efficacy of gallbladder cancer is extremely poor, and it is not sensitive to radiotherapy and chemotherapy. Therefore, gallbladder cancer is still a very difficult disease in the medical field, and the only way to improve the treatment effect is early detection and early removal of gallbladder. This requires doctors to make a more correct judgment on the many patients with gallbladder polyps. This means that gallbladder cancer can be detected early and a lot of unnecessary gallbladder removal can be avoided. In conclusion, doctors believe that: gallbladder polyp lesion is still a pre-cancerous disease and should be reviewed by ultrasound regularly to dynamically observe the change of polyp size and shape. It should be given high attention.
Treatment of gallbladder polyps, surgery should be considered for the following cases.
1.Single polyp;
2, larger than 10mm;
3.Wide base or wide base;
4, lesions with enlargement;
5, combined with gallbladder stones;
6.Age over 50 years old.
There are two surgical methods, one is removal of the gallbladder, including open resection and laparoscopic resection; the other is choledochoscopy and laparoscopy combined with endoscopic examination, biopsy and treatment of the gallbladder (also called minimally invasive biliary polyp removal). Patients can make the appropriate decisions based on the above articles and the recommendations of their local physicians.
Laparoscopic cholecystectomy is recommended first, and there are several main considerations at this time.
1, postoperative paraffin section pathology is more accurate, while minimally invasive biliary polypectomy intraoperative biopsy is mainly frozen biopsy, the accuracy of the examination results is very demanding for pathologists, and it is easy to have inconsistent frozen biopsy and postoperative paraffin section.
2, Some of the smaller polyps are not easily detected intraoperatively, and preserving the gallbladder may leave these polyps, which will still be harmful when they grow progressively in the future.
3.Intraoperative and postoperative complications of gallbladder polypectomy are higher. It also brings trouble to secondary surgery.
4, gallbladder removal has a history of more than 100 years, clinical evidence: a large number of gallbladder removal patients in various countries in the rest of his life did not appear due to the removal of the gallbladder after the serious consequences, the quality of life has not decreased due to the removal of the gallbladder. So it is proved that there is no harm to human body after gallbladder removal.