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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2018, Vol. 15 ›› Issue (01) : 19 -24. doi: 10.3877/cma.j.issn.1672-6448.2018.01.005

所属专题： 文献；

腹部超声影像学

常规超声联合超声造影测评胆囊息肉不同径线方向大小、基底部宽度在鉴别息肉性质的初步临床研究
费翔1, 罗渝昆1,†(), 唐杰1, 李岩密1, 焦子育1, 刘博2, 李杰3   
  1. 1. 100853　北京，解放军总医院超声科
    2. 100853　北京，解放军总医院外科
    3. 100853　北京，解放军总医院病理科
  • 收稿日期:2016-11-01 出版日期:2018-01-01
  • 通信作者: 罗渝昆

Pilot clinical study on predicting nature of gallbladder polyp by measuring sizes in different directions, stalk width with gray scale ultrasound and contrast-enhanced ultrasound

Xiang Fei1, Yukun Luo1,†(), Jie Tang1, Yanmi Li1, Ziyu Jiao1, Bo Liu2, Jie Li3   

  1. 1. Department of Ultrasound, PLA General Hospital, Beijing 100853, China
    2. Department of Surgery, PLA General Hospital, Beijing 100853, China
    3. Department of Pathology, PLA General Hospital, Beijing 100853, China
  • Received:2016-11-01 Published:2018-01-01
  • Corresponding author: Yukun Luo
  • About author:
    Corresponding author: Luo Yukun, Email:
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费翔, 罗渝昆, 唐杰, 李岩密, 焦子育, 刘博, 李杰. 常规超声联合超声造影测评胆囊息肉不同径线方向大小、基底部宽度在鉴别息肉性质的初步临床研究[J]. 中华医学超声杂志（电子版）, 2018, 15(01): 19-24.

Xiang Fei, Yukun Luo, Jie Tang, Yanmi Li, Ziyu Jiao, Bo Liu, Jie Li. Pilot clinical study on predicting nature of gallbladder polyp by measuring sizes in different directions, stalk width with gray scale ultrasound and contrast-enhanced ultrasound[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2018, 15(01): 19-24.

目的

探讨常规超声联合超声造影全面测评大小≥1.0 cm的胆囊息肉样病变，不同径线方向的大小以及基底部宽度在胆固醇息肉与腺瘤鉴别诊断中的价值。

方法

选取2016年1月至9月在解放军总医院因胆囊息肉样病变手术的患者81例，于手术前行胆囊超声及超声造影检查，记录患者的基本临床资料、胆囊息肉在不同方向的大小、常规超声及造影图像特征。根据手术病理结果分为胆固醇息肉组与胆囊腺瘤（包括腺瘤伴恶变）组。2组患者年龄、垂直径大小、平行径大小、基底部宽度、垂直径与基底部宽度比值（垂/基）以及平行径与基底部宽度比值（平/基）、垂直径大小与平行径大小的比值（垂/平）采用t检验，2组间性别、息肉数量、息肉部位、灰阶回声强度、有无彩色血流采用χ2检验。采用Bivariate行双变相关统计分析。

结果

胆固醇息肉组与胆囊腺瘤组患者的息肉多普勒血流、年龄、垂直径大小、平行径大小、基底部宽度、垂/基比较[9（15.8%） vs 9（37.5%），（37.02±10.14）岁 vs （52.25±13.82）岁，（0.94±0.33）cm vs （1.27±0.79）cm，1.01±0.37 vs 1.71±0.50，（0.26±0.10）cm vs （0.58±0.51）cm，3.82±1.87 vs 2.92±1.61]，差异均有统计学意义（χ2=2.675，t=5.303、2.675、5.855、4.566、-2.536，P均<0.05），而垂/平、平/基比较，差异均无统计学意义（P均>0.05）。垂直径大小、平行径大小、基底部宽以及垂直径大小与基底部宽度比值均与胆囊息肉样病变的性质有相关关系（r=0.375、0.571、0.586、-0.342，P均<0.05）。

结论

通过常规超声以及超声造影全面测评息肉不同径线方向的大小、基底部宽度对于鉴别大小≥1.0 cm的胆囊息肉的性质有重要临床意义。

关键词: 胆囊疾病, 腺瘤性息肉, 超声检查
Objective

To evaluate clinical application of measuring the sizes in different directions and stalk width of gallbladder polyp lesions (GPL) ≥1.0 cm for differentiation diagnosis between cholesterol polyp and adenoma by both gray scale ultrasound (US) and contrast-enhanced ultrasound (CEUS).

Methods

From January to September 2016, a total of 81 patients with GPL≥1.0 cm received cholecystectomy in our hospital were enrolled in this study. All participations underwent US and CEUS scanning before cholecystecomy. Patient′s clinical data, sizes in different directions, stalk width and features of US images were recorded. According to pathological findings, patients were divided into cholesterol polyp group and adenoma group. All of the clinical data, sizes, stalk width and features of US images were statistically analyzed. Patient′s age, size in vertical and parallel sizes, stalk width of GPL, ratio of vertical size to stalk width, ratio of parallel size to stalk width and ratio of vertical size to parallel size were compared with t-test. Genda, number and location of GPL, echoic level and blood flow signal were compared with the χ2 test. Bivariate was used for relation analysis.

Results

There were difference in patient′s age, vasularity of GPL, size in vertical direction, size in parallel direction, stalk width, ratio of vertical size to stalk width, ratio of parallel size to stalk width [9(15.8%) vs 9(37.5%), (37.02±10.14) years old vs (52.25±13.85) years old, (0.94±0.33)cm vs (1.27±0.79)cm, 1.10±0.37 vs 1.71±0.50, (0.26±0.10)cm vs (0.58±0.51)cm, 3.82±1.87 vs 2.92±1.61], the differences were statistically significant (χ2=2.675, t=5.303, 2.675, 5.855, 4.566, -2.536, all P<0.05), but no difference in ration of vertical size to parallel size between two groups (all P>0.05). Bivariate realtion analysis proved that size in vertical direction, size in parallel direction, stalk width and ratio of vertical size to stalk width were related with the nature of GPL≥1.0 cm (r=0.375, 0.571, 0.586, -0.342, all P<0.05).

Conclusion

Sizes in different directions and stalk width were important factors for predicting the nature of GPL ≥1.0 cm.

Key words: Gallbladder diseases, Adenomatous polyps, Ultrasonography
表1 胆固醇息肉组与胆囊腺瘤组患者一般情况及常规超声图像特征
参数 胆固醇息肉组（57例） 胆囊腺瘤组（24例） 统计值 P值
年龄（岁，±s） 37.02±10.14 52.25±13.82 t=5.303 <0.001
性别（例） ? ? χ2=0.457 0.49
? 男性 17 9 ? ?
? 女性 40 15 ? ?
息肉数量（例） ? ? χ2=3.806 0.05
? 单发 41 22 ? ?
? 多发 16 2 ? ?
息肉部位（例） ? ? χ2=5.047 0.08
? 底部 13 2 ? ?
? 体部 30 19 ? ?
? 颈部 14 3 ? ?
灰阶回声强度（例） ? ? χ2=0.990 0.32
? 高回声 24 13 ? ?
? 非高回声 33 24 ? ?
彩色血流（例） ? ? χ2=4.606 0.03
? 有 9 9 ? ?
? 无 48 15 ? ?
图1~4 胆囊胆固醇息肉不同方向大小与基底部宽度超声图像。图1为常规超声示胆囊壁息肉样病变，息肉呈等回声，垂直径大小1.3 cm，平行径大小0.7 cm；图2为彩色多普勒超声示病变内无明显血流；图3为超声造影动脉期病变有较窄的基底部（箭头所示），病变附着处胆囊壁无明显增厚；图4为超声造影动脉期示病变基底部宽度为2.4 mm
图5~7 胆囊腺瘤性息肉不同方向大小与基底部宽度超声图像。图5为常规超声示胆囊多发息肉样病变，较大息肉位于胆囊底部，垂直径大小1.7 cm，平行径大小1.0 cm；图6为超声造影动脉期示较大者息肉基底部较窄，息肉附着处胆囊壁无明显增厚（箭头所示）；图7为超声造影动脉期示息肉基底部宽度为1.8 mm，周围胆囊壁厚约2.6 mm
图8~11 胆囊腺瘤伴恶变（侵犯浆膜层）超声图像。图8为常规超声显示胆囊息肉样病变，息肉位于胆囊底部呈等回声（箭头所示）；图9为息肉垂直径大小1.9 cm，息肉平行径大小1.4 cm；图10为彩色多普勒超声示病变内无明显血流；图11为超声造影动脉期示息肉基底部较宽，宽约5.6 mm，息肉附着处胆囊壁较周围胆囊壁增厚
表2 胆固醇组与胆囊腺瘤组息肉不同方向大小与基底部宽度（±s）
组别 例数 垂直径大小（cm） 平行径大小（cm） 垂/平 基底部宽度（cm） 垂/基 平/基
胆固醇息肉组 57 0.94±0.33 1.10±0.37 1.05±0.77 0.26±0.10 3.82±1.87 4.59±1.74
胆囊腺瘤组 24 1.27±0.79 1.71±0.50 0.73±0.26 0.58±0.51 2.92±1.61 3.96±1.81
t值 ? 2.675 5.855 -1.972 4.566 -2.536 -1.464
P值 ? 0.009 <0.001 0.052 <0.001 0.013 0.147
1
Cha BH, Hwang JH, Lee SH, et al. Pre-operative factors that can predict neoplastic polypoid lesions of the gallbladder [J]. World J Gastroenterol, 2011, 17(7):2216-2222.
2
Sarkut P, Kilicturgay S, Ozer A, et al. Gallbladder polyps: Factors affecting surgical decision [J]. World J Gastroenterol, 2013, 19(28):4526-4530.
3
Fei X, Lu WP, Luo YK, et al. Contrast-enhanced ultrasound may distinguish gallbladder adenoma from cholesterol polyps: a prospective case-control study [J]. Abdom Imaging, 2015, 40(7):2355-2363.
4
Wiles R, Thoeni RF, Barbu ST, et al. Management and follow-up of gallbladder polyps: Joint guidelines between the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Association for Endoscopic Surgery and other Interventional Techniques (EAES), International Society of Digestive Surgery - European Federation (EFISDS) and European Society of Gastrointestinal Endoscopy (ESGE) [J]. Eur Radiol, 2017, 27(9):3856-3866.
5
Yuan HX, Cao JY, Kong WT, et al. Contrast-enhanced ultrasound in diagnosis of gallbladder adenoma [J]. Hepatobiliary Pancreat Dis Int, 2015, 14(2):201-207.
6
Kim JS, Lee JK, Kim Y, et al. US characteristics for the prediction of neoplasm in gallbladder polyps 10 mm or larger [J]. Eur Radiol, 2016, 26(4):1134-1140.
7
Inui K, Yoshino J, Miyoshi H. Diagnosis of gallbladder tumors [J]. Intern Med, 2011, 50(11):1133-1136.
8
Lee KF, Wong J, Li JC, et al. Polypoid lesions of the gallbladder [J]. Am J Surg, 2004, 188(2):186-190.
9
Xu HX. Contrast-enhanced ultrasound in the biliary system: Potential uses and indications [J]. World J Radiol, 2009, 1(1):37-44.
10
Gallahan WC, Conway JD. Diagnosis and management of gallbladder polyps [J]. Gastroenterol Clin North Am, 2010, 39(2):359-367.
11
Park HY, Oh SH, Lee KH, et al. Is cholecystectomy a reasonable treatment option for simple gallbladder polyps larger than 10 mm? [J]. World J Gastroenterol, 2015, 12(14):4248-4254.
12
French DG, Allen PH, EIIsmere J. The diagnostic accuracy of transabdominal ultrasonography needs to be considered when managing gallbladder polyps [J]. Surg Endosc, 2013, 27(11):4021-4025.
13
Sarkut P, Kilicturgay S, Ozer A, et al. Gallbladder polyps: factors affecting surgical decision [J]. World J Gastroenterol, 2013, 19(28):4526-4530.
14
Andrén-Sandberg A. Diagnosis and management of gallbladder polyps [J]. N Am J Med Sci, 2012, 4(5):203-211.
15
Maciejewski P, Strzelczyk J. Is gall-bladder polyp equivalent to cancer? An analysis of material from 1196 cholecystectomies--acomparison of the ultrasound and histopathological results [J]. Pol Przegl Chir, 2014, 85(5):218-222.
16
Boulton RA, Adams DH. Gallbladder polyps: when to wait and when to act [J]. Lancet, 1997, 349(9055):817.
17
European Association for the Study of the Liver (EASL). EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones [J]. J Hepatol, 2016, 65(1):146-181.
18
Bhatt NR, Gillis A, Smoothey CO, et al. Evidence based management of polyps of the gall bladder: A systematic review of the risk factors of malignancy [J]. Surgeon, 2016, 14(5):278-286.
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