Abstract:

Standardized treatment of asymptomatic gallstones and gallbladder polyps from the perspective of overtreatment and inadequate treatment        ZHAO Hai-ying，LIU Jin-gang. Department of General Surgery, the Fourth Affiliated Hospital of China Medical University，Shenyang 110032，China
Corresponding author：LIU Jin-gang，E-mail：liujg51347@
hotmail.com
Abstract    Domestic and international treatment guidelines recommend that asymptomatic gallstones do not need prophylactic laparoscopic cholecystectomy (LC), gallbladder polyps ≥1cm in diameter need LC. In clinical work, there may be overtreatment and inadequate treatment. It recommend that the majority of asymptomatic gallstones do not need prophylactic LC. For the patients in whom expecting treatment may increase the operation risk, observation should be preferred. In the presence of risk factors of gallbladder cancer, LC should be performed timely. In the presence of gallbladder wall thickening (＞3mm), regardless of the polyps size, LC should be recommended. Without gallbladder wall thickening, polyp ≥1cm, or increases rapidly in short term (＞3mm/6m), LC should be recommended. When the number of polyps increased or atypical abdominal symptoms is not in the indications for LC, observation should be preferred. Surgeons should pay attention to standardized treatment of asymptomatic gallstones and gallbladder polyps, strictly follow the guidelines, and avoid overtreatment, protect gallbladder function, and avoid inadequate treatment, perform LC for the precancerous lesions timely.

Key words: asymptomatic gallstones, gallbladder polyps, laparoscopic cholecystectomy, overtreatment

摘要：

国内外治疗指南推荐无症状性胆囊结石无须行预防性腹腔镜胆囊切除术（LC），胆囊息肉直径≥1 cm时才行LC。但实际临床工作中，可能存在过度治疗与治疗不足的现象。大部分无症状性胆囊结石，无须行预防性LC，对期待治疗可能增加手术风险的病人，首选定期复查，当存在胆囊癌高危因素时，积极行LC。推荐胆囊壁厚＞3 mm时，无论息肉大小，均行LC；胆囊壁无增厚时，息肉直径≥1 cm，或者短期内迅速增大（＞3 mm/6个月），行LC；息肉数目增多或出现不典型腹部症状时，建议观察。临床医生应重视无症状性胆囊结石、胆囊息肉的规范化治疗，严格遵守国内治疗指南，避免过度治疗，保留胆囊功能，同时避免治疗不足，争取在癌前病变阶段及时手术。

关键词: 无症状性胆囊结石, 胆囊息肉, 腹腔镜胆囊切除术, 过度治疗