内镜保胆息肉切除术治疗胆囊息肉初探

目的评价内镜保胆息肉切除术治疗胆囊息肉的疗效及安全性。方法对2017年9月—2019年8月于复旦大学附属中山医院内镜中心接受内镜保胆息肉切除术治疗的25例胆囊息肉病例进行回顾分析,观察手术完成情况、手术用时、术后住院时间、并发症发生情况及随访情况。结果单发息肉13例、多发息肉12例,单纯胆囊息肉13例、合并胆囊结石12例,息肉最大径0.2~1.5 cm。1例(4%)经胃开窗进入腹腔后,因腹腔严重黏连,探查未见胆囊,终止操作,手术失败;其余24例(96%)成功接受内镜保胆息肉切除术治疗,手术时间(67.1±26.8)min(35~140 min),术后中位住院时间4 d(2~5 d),无迟发性出血、迟发性穿孔、弥漫性腹膜炎、腹腔脓肿等并发症。中位随访时间8个月(0~23个月),无患者失访,无息肉复发,无金属夹相关严重不良反应。结论内镜保胆息肉切除术治疗胆囊息肉安全且短期疗效显著,但其远期疗效仍需进一步大样本研究。

Clinical value of endoscopic trans-gastric gallbladder-preserving polypectomy for gallbladder polyps

Objective To evaluate the efficacy and safety of endoscopic trans-gastric gallbladder-preserving polypectomy in treatment of gallbladder polyps. Methods A retrospective analysis was performed on data of 25 patients with gallbladder polyps who underwent endoscopic trans-gastric gallbladder-preserving polypectomy in the endoscopy center of Zhongshan Hospital from September 2017 to August 2019. Completion of operation, operation time, postoperative hospital stay, complications and follow-up results of patients were obtained and analyzed. Results There were 13 cases of single polyp and 12 cases of multiple polyps, 13 cases of simple gallbladder polyps, and 12 cases of polyps and gallstones. The maximum diameter of polyps was 0.2-1.5 cm. The procedure failed in 1 patient (4%) because of the severe adhesion of abdominal cavity and disappearance of gallbladder when passing through the gastric wall. Twenty-four patients (96%) were successfully treated with endoscopic trans-gastric gallbladder-preserving polypectomy. The operation time was 67.1±26.8 min (35-140 min). The median hospital stay was 4 d (2-5 d). No severe adverse events including delayed bleeding, delayed perforation, diffuse peritonitis or abdominal abscess occurred. During the median follow-up time of 8 months (0-23 months), no patient was lost, no recurrence of polyps and no severe adverse events related to metal clips occurred. Conclusion Endoscopic trans-gastric gallbladder-preserving polypectomy shows good short-term efficacy and is technically feasible, however, long-term outcome still requires further research.