The Timing Of Surgery For Polypoid Lesions Of The Gallbladder:A Report Of 625 Cases

Objective:To analyze the clinical data of patients with gallbladder polyposis retrospectively,combined with relative literatures,to study the risk factors of malignant transformation of gallbladder polyposis and the reasonable operation timing of gallbladder polyposis.Methods:Collecting of 827 cases of PLG hospitalized and accepted operation treatment in the First Affiliated Hospital of Nanchang University from January 1,2010 to December 31,2015.A total of 625 cases lined with the study enrollment criteria were studied.The univariate analysis and multivariate logistic regression analysis were used to determine the risk factors of malignant transformation of PLG.First,patients were divided into tumor group and non-tumor group,The tumor group was divided into adenoma group and adenocarcinoma group.Then,according to Wang Qiusheng classification of PLG,Qpatients were divided into cholesterol polyp group,benign non-cholesterol polyp group,adenocarcinoma group.Benign PLG group included cholesterol polyp group and benign non-cholesterol polyp group.The differences in clinical characteristics were compared between tumor group and non-tumor group、cholesterol polyp group and benign non-cholesterol polyp group、adenoma group and non-tumor group、adenocarcinoma group and benign PLG group、adenoma group and adenocarcinoma group.Results:There were 599 benign PLG and 26 malignant PLG in total of 625 patients.Malignant PLG univariate analysis showed that age,lesion size,symptoms,number of lesions,cholecystolithiasis,or cholecystitis were risk factors related with malignant PLG(P<0.05).And multivariate logistic regression analysis showed that age,lesion size were the independent risk factors(P<0.05).2.In the age and malignant PLG ROC curves,when the age was 55.5 years old,the Youden’s index had maximum value of 0.604;In the lesion size and the malignant PLG ROC curve,when the lesion size was 1.35cm,the Youden’s index had maximum value of 0.704.3.When studying between age groups(<55.5years,≥55.5years),between lesion size groups(<1.35cm,≥1.35cm):a.When studying between the tumor group and the non-tumor group,the difference in the symptoms,gallbladder wall thickness,gallbladder stones,or cholecystitis showed no significant statistically(P>0.05),but the differences in age,the lesion size,the number of lesions were significant(P<0.05);b.When studying between the CPs and the non-CPs benign groups,the difference in the in the age,symptoms,gallbladder wall thickness,gallbladder stones or cholecystitis showed no significant statistically(P>0.05).but the differences in lesion size,the number of lesions was significant(P<0.05);c.When studying between the adenomas groups and non-tumor groups,the difference in the age,gallbladder wall thickness,gallbladder stones,or cholecystitis showed no significant statistically statistically(P>0.05),but the differences in lesion size,symptoms,and number of lesions were significant(P<0.05).d.When studying between adenocarcinoma group and benign PLG group,the difference in gallbladder wall thickness showed no significant statistically(P>0.05),but the differences in lesion size,age,symptoms,number of lesions,gallbladder stones or cholecystitis were significant statistically(P<0.05).e.When studying between the adenoma group and the adenocarcinoma group,the difference in gallbladder wall thickness and number of lesions showed no significant statistically(P>0.05),but the differences in lesion size,age,symptoms,gallbladder stones or cholecystitis were significant statistically(P<0.05).Conclusion:1.The age ≥ 55.5 years,and lesion size of≥ 1.35cm were independent risk factor for malignant PLG;2,For PLG patients having the following conditions,surgical treatment should be considered:1、age ≥ 55.5 years old;2、single lesion,pedicle or wide base;3、concurrence with gallstones or cholecystitis,or unexplained symptoms;4、lesion size>1.35cm.