Gallbladder polypoid lesion (polypoid lesion of gallbladder) is a generalized term for all non-calculous lesions in which the wall of the gallbladder grows polypoidly into the lumen. In China, with the widespread popularization of ultrasound technology, the detection rate of polypoid lesion of gallbladder is getting higher and higher, and its clinical and pathological characteristics as well as the timing of surgery have been widely studied. If the gallbladder polyp is larger than 1 cm, it is best to first surgical treatment to eliminate the occurrence of cancer.
Clinical manifestations:
Most of the symptoms of gallbladder polyps are similar to those of chronic cholecystitis, which are mainly characterized by mild discomfort in the right upper abdomen, and biliary colic when accompanied by stones, but a considerable number of patients do not have any symptoms, and they are only discovered when they have a health checkup. It is generally believed that gallbladder polyp is a predisposing factor for gallbladder cancer, and in recent years there have been many domestic and foreign reports on the cancerous transformation of gallbladder polyp, especially when accompanied by stones, the chances of cancerous transformation will be significantly increased.
Gallbladder polyps can be clinically divided into three periods, namely: active growth period, relatively stable period, absorption and dissipation period. In the treatment, it is generally necessary to go through the process of "active growth period - relatively stable period - absorption and dissipation period", and the characteristics of each period are as follows:
There are many reports about the cancer of gallbladder polyps at home and abroad in recent years. The characteristics of each period are as follows:
Active growth period Relative stabilization period Absorption and dissipation period
The volume of gallbladder polyps Increasing in size No change Gradual decrease
The number of gallbladder polyps Increasing in number No change Gradual decrease
Clinical characteristics of gallbladder polyps
Feature 1: Gradual increase of incidence
With diversification of the diet structure of human beings and intensification of dietary patterns and environmental pollution, there is an increase of the incidence of gallbladder polyps in the world. With the diversification of human dietary structure and dietary rhythms and the aggravation of environmental pollution, the incidence of gallbladder polyps is gradually increasing, such as: high cholesterol diet, long-term alcoholism, eating too much stimulating diet, dietary disorders, such as: not eating a good breakfast or not eating breakfast, too much dinner, too much and other bad eating habits, too much pesticides, food additives, ionizing radiation filled space, etc. are directly and indirectly related to the formation of gallbladder polyps, which gave birth to the first characteristics of gallbladder polyps. The first feature of gallbladder polyps - a gradual increase in incidence.
Feature 2: Hidden aggressiveness
Gallbladder polyps are mostly asymptomatic, and more than 85% of patients are found during routine physical examinations. On examination, polyps below 3-4mm are difficult to detect or often missed in CT and nuclear magnetic **** vibration.
Asymptomatic gallbladder polyps give people the false impression that it does not hurt, the body is not sick, no need for treatment, and when the symptoms are concurrent or the nature of the change, often to cause unexpected pain and irreparable damage, the typical patient often have the feeling that: woke up, it is too late.
With the development of imaging, the discovery rate of gallbladder polyposis gradually increased, and non-specialized hospital doctors do not know or do not recognize this disease, or do not pay attention to it, thus causing gallbladder polyposis in the diagnosis and cognition of the blind spot and diagnosis of a vacuum in the treatment of gallbladder polyposis, the formation of gallbladder polyposis of a wide hidden space.
The above three points breed the hidden aggressiveness characteristics of gallbladder polyps.
Feature 3: High cancer rate
The fatal killing power of gallbladder polyps lies in the sudden cancerous transformation. From the 80s to the 90s, the rate of cancerous transformation gradually increased due to the different nature of the formed gallbladder polyps. However, during or after the cancerous transformation, many patients with gallbladder polyps do not feel any discomfort, unknowingly develop and become cancerous without realizing it, which is the most frightening feature of gallbladder polyps.
Diagnosis and differentiation:
Gallbladder polypoid lesion is also known as gallbladder bulge-like lesion, the clinical symptoms of this disease are not specific, and most of the patients are found during physical examination. The main symptom was vague pain in the middle and upper abdomen (46.9%). The age of onset of the disease was 30-50 years old, accounting for 57.8%, with young and middle-aged people predominating. The diagnosis of gallbladder polyps mainly relies on ultrasonography. However, it is often difficult to characterize, and the differential diagnosis of its benign and malignant nature is also difficult. At present, the main diagnostic means is ultrasonography, the detection rate of <5mm can reach more than 90%, and the sensitivity and accuracy of diagnosis are high. If multiple high intensity echoes are found, and there is a sense of floating and the Wise Tail sign suggests cholesterol polyps, located in the bottom of the gallbladder small bulges, lesions with small round vesicles and scattered echogenic spots suggest adenomyomatosis, and according to the nature of the lesion echogenicity, the presence or absence of tibial thickness, the mucosal changes at the lesion, it is valuable in distinguishing between benign and malignant diseases. However, ultrasonography has some limitations and false-negative rates in the diagnosis, characterization and differential diagnosis of this disease. For example, when the lesion is small and located in the neck of the gallbladder, or accompanied by gallbladder stones, it is easy to cause missed diagnosis, and it is also difficult to characterize and differentiate.
Tumor classification
Gallbladder polyps, also known as gallbladder bulge-like lesions or gallbladder tumors, can be divided into true tumors and pseudotumors when analyzed in the sense of gallbladder tumors. The so-called true tumor refers to gallbladder polyps caused by hyperplasia of the glands and muscular layer of the gallbladder itself, which is a kind of tumor of the gallbladder in the true sense of the word, and the characteristics of this kind of gallbladder polyps are shown in the following table. The so-called pseudotumor refers to the cholesterol accumulation and crystallization due to the dysfunction and disorder of liver and gallbladder clearance, inflammatory hyperplasia caused by chronic inflammation of gallbladder, and other proliferative lesions caused by abnormal changes of gallbladder and bile.
Treatment and prevention:
Gallbladder polyp lesions are not uncommon in clinical practice, and surgery is a radical cure, but not all gallbladder polyps require surgical treatment. Because of the different types of lesions, different sizes, disease regression is not the same, so its surgical indications are not consistent.
The timing of surgery: gallbladder polyposis is sometimes difficult to characterize before surgery. According to the high-risk factors for malignant transformation of gallbladder polypoid lesions, we propose the following indications for surgery:
(1) Single lesion, larger than 10 mm, with a large tip, especially in the neck of the gallbladder, and age greater than 50 years. (2) Multiple lesions with gallbladder stones, symptomatic, and age greater than 50 years. (3) Single lesion, less than 10mm, asymptomatic, age less than 50 years old, allowing observation and follow-up; lesion enlargement or changes in morphology should be treated surgically. (4) Doppler ultrasound examination of the lesion with rich blood supply suggests that it is a malignant neoplasm. (5) CEA (tumor marker), the measured value is obviously elevated and other gastrointestinal tumors are excluded. (6) Gallbladder polypoid lesions with obvious symptoms and recurrent recurrence. (7) Asymptomatic patients with a diameter of less than 5 mm should be followed up at intervals of 3 to 5 months. Once the lesion increases in size or the symptoms are obvious, surgical treatment is also required.
In recent years, non-surgical and traditional Chinese medicine treatment of gallbladder polyps has attracted extensive attention from the medical community, and various prescriptions, formulas, and tests have achieved certain results in anti-inflammatory, choleretic, and controlling cholecystitis and gallbladder polyps, etc. Specialized medications for gallbladder polyps have also achieved great success, and with the in-depth study of Chinese medicine and traditional Chinese medicine, the cure rate of non-surgical treatment of gallbladder polyps has also been rapidly increasing.
"Prevention"
Banning alcohol and alcoholic beverages
Alcohol in the body is mainly decomposed and detoxified by the liver, so alcohol can directly damage the liver function, cause liver and gallbladder dysfunction, and disorganize the secretion and discharge of bile, which can stimulate the formation of new polyps in the gallbladder and/or cause the original polyps to grow and get bigger, thus increasing the cancerous coefficient of gallbladder polyps.
Eating a regular diet and a good breakfast
Eating a regular diet and a good breakfast is extremely important for patients with gallbladder polyps. The liver is responsible for the secretion of bile, which is stored in the gallbladder, and the function of bile is mainly to digest oily food. If you don't eat breakfast, the bile secreted at night is not utilized, stored in the gallbladder, bile in the gallbladder for a long time, you can stimulate the gallbladder to form gallbladder polyps or make the original polyp increase, so breakfast is best to eat some food containing vegetable oil.
Low cholesterol diet
Excessive cholesterol intake can increase the metabolism of the liver and gallbladder, clean up the burden, and cause excess cholesterol in the wall of the gallbladder crystals, accumulations and deposits, thus forming polyps, so patients with gallbladder polyps should reduce the amount of cholesterol intake, especially in the evening, should be avoided to eat high cholesterol foods such as: eggs (especially egg yolks), fatty meats, seafood, scaly fish, animal organs and other foods.
Other dietary precautions
1, it is advisable to eat a variety of fresh fruits and vegetables, into the low-fat, low-cholesterol foods such as: mushrooms, fungus, celery, bean sprouts, kelp, lotus root, fish, rabbit, chicken, fresh beans and so on.
2. It is advisable to eat more dry beans and their products.
3, it is advisable to use vegetable oil, not animal oil.
4, eat less chili, raw garlic and other stimulating food or spicy food
5, it is appropriate to use boiling, steaming, braising, stir-frying, mixing, blanching, stewing cooking methods, do not use oil frying, deep-frying, baking, smoking cooking methods.
6, hawthorn 10 grams, 10 grams of chrysanthemum, cassia 15 grams, decoction tea or drinking green tea.
7, usually drink water, pinch a little hawthorn, sea buckthorn, ginkgo biloba, gibberellic acid grass into a cup of water as tea.