Physical examination of gallbladder polyps

The symptoms of gallbladder polyps are not very obvious, and many patients discover gallbladder polyps occasionally during physical examinations. Regardless of how gallbladder polyps are diagnosed, they must be treated promptly. The specific method needs to be formulated based on the patient's condition. In a small number of patients, gallbladder polyps are malignant and the consequences are very serious. Let's take a look at the main treatments for gallbladder polyps.

It mainly involves the determination of benign or malignant nature of gallbladder polyps, so as to achieve early detection of malignant lesions and precancerous lesions and early surgical resection.

1. Risk factors for malignant transformation of gallbladder polyps and surgical indications

(1) The size of gallbladder polyps Most scholars believe that the size of gallbladder polyps is related to their benign or malignant nature. Small gallbladder polyps (<10 mm in diameter) have been found to be mostly benign lesions and can remain unchanged for many years. Large gallbladder polyps suggest malignancy.

(2) Age: The average age of patients with gallbladder polyps, gallbladder adenoma and gallbladder cancer, as well as the diameter of gallbladder polyps are significantly larger than those of patients with non-tumor polyps.

(3) The number and morphology of polyps: Single and broad-based polyps are prone to canceration. The malignant changes of gallbladder polyps tend to occur in older, solitary, and large gallbladder polyps.

(4) Combined with gallstones The relationship between gallbladder cancer and gallstones is relatively clear. Some patients with gallbladder cancer may also have gallstones. The long-term stimulation of gallstones can promote the proliferation of gallbladder epithelial cells and cause cancer. Therefore, the presence of stones increases the risk of gallbladder cancer.

(5) Malignant gallbladder polyps with associated clinical symptoms are more likely to be accompanied by clinical symptoms.

Based on the above risk factors for malignant transformation of gallbladder polyps, for young patients with gallbladder polyps, if the diameter of the polyps is small (10mm) and there are no symptoms at all, there is no need for surgery; for patients with obvious biliary colic, especially those with gallstones, cholecystectomy should be performed; for patients with polyps with a diameter >10mm and risk factors for malignant transformation of gallbladder polyps, cholecystectomy should be performed as soon as possible. For patients with polyp diameter less than 10mm and who do not have risk factors for malignant transformation of gallbladder polyps, they can be observed and regularly examined by ultrasound.

2. Choice of surgical method

For patients with gallbladder polyps with a diameter less than 10 mm, multiple pedunculated polyps, it is suggested that the lesions are likely to be pseudotumor polyps, and laparoscopic cholecystectomy is the first choice. For patients with polyp diameter >10mm and risk factors for malignant transformation of gallbladder polyps, it is suggested that they are tumorous polyps and routine open cholecystectomy should be performed. Frozen sections are routinely performed during surgery to clarify the pathological category. If it is a cancerous polyp, simple cholecystectomy can be performed when the tumor is limited to the mucosa; once the tumor invades the muscular layer, extended resection is required, including wedge resection of the gallbladder bed liver and lymph node dissection.

Although there are many controversies in the surgical treatment of gallbladder polypoid lesions, in general, gallbladder polyps with a diameter >10mm, age >50 years, solitary, broad-based, and combined gallstones have been considered risk factors for malignant transformation of gallbladder polyps. Patients suitable for surgery can be selected based on these risk factors. For gallbladder polyps with a diameter of less than 10 mm and no clinical symptoms, ultrasound examination can be performed regularly. If abnormalities are found, preventive surgical resection can be performed.