| Background:Gallbladder polyp(Gallbladder polyps,GBPs)is a general term for lesions in gallbladder cavity,about 5-7%detected in adults.With the development of imaging examination,the detection of gallbladder polyps increased.Previous studies recommended that polyp size≥ 1cm as an indication of surgical treatment and cholecystectomy as a first-line treatment of gallbladder polyps to prevent polyps from turning into cancer.Recent studies suggest that most of gallbladder polyps are benign lesions such as cholesterol polyps and the presence of gallbladder polyps does not affect gallbladder function.In addition,about 16.4%had no obvious gallbladder polyps.Many literatures have reported cholecystectomy can cause long-term postoperative complications and increase the risk of colorectal cancer.Therefore,gallbladder polypectomy with gallbladder preservation should be an alternative treatment.NOTES(natural orifice transluminal endoscopic surgery)is a new technique that through the natural cavity of human body(oral cavity,vagina,anus,etc.)without abdominal wall incision for endoscopic treatment.Since the first NOTES cholecystectomy was completed in 2015,many scholars have carried out extensive researches on the safety and effectiveness of this procedure,among which Liu’s team has completed hundreds of NOTES operations.Meanwhile,numerical researchers believe that cholecystectomy in some terms may lead to operation.related complications,and remove gallbladder with good function.More scholars proposed that small polyps with good gallbladder function or patients with mild symptoms choose to preserve gallbladder,which means remove the lesions and maintain the normal storage,concentration and excretion of bile and avoid many effects after cholecystectomy.Aims:The aim of this study was to review the clinical outcome of NOTES gallbladder-preserving polypectomy and laparoscopic cholecystectomy,further evaluate their effectiveness and safety.Methods:In this retrospective study,analysis and propensity matching score were used to collect 322 patients with gallbladder polyps treated by laparoscopic cholecystectomy and NOTES gallbladder-preserving polypectomy in the first affiliated Hospital of Zhengzhou University from December 2016 to October 2020,including 303 cases of laparoscopic cholecystectomy and 19 cases of NOTES gallbladder-preserving polypectomy.Through the propensity score matching to select comparable patients for comparison.In the SPSS 26.0 software,the Match Ratio was set to 1:1.Matched analysis was performed in 19 cases of cholecystectomy and 19 cases of gallbladder polypectomy with NOTES.The average age of cholecystectomy group was 46.8±12.3 years,including 7 males and 12 females,and that of NOTES cholecystectomy group was 42.1 ±11.2 years old,14 males and 5 females.The general data,preoperative data,surgical data and postoperative follow-up data of 38 patients were collected and compared.Results:1.The success rate of operation in 38 patients was 100%,and the removal rate of polyps was 100%.NOTES gallbladder polypectomy group:transrectal approach in 8 cases(42.1%),trans-gastric approach in cases(57.9%).The number of polyps was single in 6 cases(31.6%),multiple(≥2)in 13 cases(68.4%),the median duration of operation was 155.4 ±63.1 minutes,and no adverse events were recorded during the operation.Postoperative abdominal drainage was performed in 1 case(5.3%)due to gastric fistula.Postoperative discomfort included fever(≥ 38.5℃)in 3 cases(15.8%),nausea and vomiting in 1 case(5.3%),and painkillers use in 6 cases(31.6%).The fasting day after operation was 2.4±1.6 days,and operative complications included gastric fistula in 1 case(5.3%).Conservative treatment was performed with abdominal drainage and irrigation.There was no reoperation or transferred to intensive care unit.The average postoperative hospital stay was 5.6±4.0 days,and the postoperative histopathological types were cholesterol polyps in 14 cases(73.7%),mucosal Polypoid hyperplasia in 4 cases(21.0%),and adenoma in 1 case(5.3%).As of March,2021,the average follow-up time was 23 months(6Power45),18 cases were followed up(94.7%),1 case refused follow-up(2.6%),and the postoperative symptom remission rate was 100%.During the follow-up period,discomfort symptoms included intermittent tolerance of right upper abdominal pain in 1 case(5.5%)and back pain in 1 case(5.5%).There were no symptoms such as abdominal distension,poor appetite,constipation,fat intolerance,nausea,vomiting and acid heartburn.During the follow-up period,there were no recurrence of gallbladder polyps,gallstone formation in 3 cases(7.9%),cholecystitis in 2 cases(5.3%),conservative treatment and additional cholecystectomy in 1 case(2.6%).2.In the laparoscopic cholecystectomy group,single polyps in 8 cases(42.1%),multiple polyps in 11 cases(57.9%),the median duration of operation was 66.9±50.5 minutes,and no adverse events were recorded during the operation.Postoperative abdominal drainage was performed in 19 cases(100%).Postoperative special discomfort included incision pain in 9 cases(47.4%),pain lasting 1.1 days,painkillers in 3 cases(15.8%),fever(≥38.5℃)in 1 case(5.3%).The duration of postoperative fasting was 2.0±0.7 days,no short-term complications occurred,and the postoperative hospital stay was 5.32±2.4 days.The postoperative histopathological types were cholesterol polyp in 10 cases(52.6%),mucosal Polypoid hyperplasia in 5 cases(26.3%),adenoma in 4 cases(21.0%),gallstone in 2 cases(10.5%),low-grade glandular intraepithelial neoplasia in 1 case(5.3%).Advanced glandular intraepithelial neoplasia in 1 case(5.3%).Until February 2021,the average follow-up time was 35 months(18,49),18 cases(94.7%)were followed up and 1 case(2.6%)lost follow-up.During the follow-up period,52.6%patients were found to have post-cholecystectomy syndrome.Symptoms include fat intolerance in 6 cases(33.3%),intermittent tolerance to right upper abdominal pain in 5 cases(27.8%),and changes in stool habits in 4 cases(22.2%).Abdominal distension occurred in 2 cases(11.1%),back pain in 1 case(5.5%),and heartburn in 1 case(5.5%).There was no anorexia,nausea and vomiting.Conclusions:1.Our preliminary results show that both laparoscopic cholecystectomy and NOTES gallbladder-preserving polypectomy are feasible and effective options for gallbladder polyps.2.Laparoscopic cholecystectomy has the advantages of short operation time,but it is easy to develop post-cholecystectomy syndrome.3.NOTES not only removes the lesion,but also retains the biological function of the gallbladder,no scar on body surface and short duration of postoperative pain,but has problems such as immature operation. |
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