朋友體檢完畢，超聲發(fā)現(xiàn)膽囊息肉，11mm大小。上網(wǎng)查一查后，去醫(yī)院門診：醫(yī)生說要癌變！要手術(shù)，切除膽囊！朋友一聽要變癌和手術(shù)，就嚇了一跳，這可怎么辦？首先，咱們看看專業(yè)知識：膽囊息肉發(fā)生率約3%-9%，膽囊息肉實(shí)際上只是醫(yī)療影像學(xué)上看到膽囊里有息肉樣的組織影，并不能完全分辨是什么具體類型。所以，患者朋友不要隨便杯弓蛇影，對號入座，自己嚇自己！臨床上的影像學(xué)檢查如超聲、CT、核磁共振等等，僅能夠初步分辨膽囊息肉的良惡性，加上70%以上的膽囊息肉都是良性的，不會(huì)惡變，因此膽囊息肉的處理方案就具有相當(dāng)?shù)牟淮_定性。看看西方多個(gè)國家對膽囊息肉共同提出的處理方案吧！從這份來自歐洲關(guān)于膽囊息肉的專家指南看出：當(dāng)膽囊息肉符合以下幾種情況時(shí)，建議切除膽囊： 膽囊息肉直徑≥10mm；（因?yàn)橄⑷庾儼╋L(fēng)險(xiǎn)隨尺寸增大而升高） 膽囊息肉6mm≤直徑＜10mm，同時(shí)有以下危險(xiǎn)因素，建議切除：①合并膽囊炎、膽囊結(jié)石；②息肉單發(fā)、無蒂（膽囊壁增厚＞4mm），且迅速增大（在6個(gè)月~5年隨訪期內(nèi)增大2mm以上）；③年齡超過50歲；3.膽囊病變引起不適癥狀，或超聲檢查提示膽囊息肉血供豐富，懷疑癌變等；當(dāng)然，我們中國專家也有類似的共識，提出惡性膽囊息肉有以下特征，建議手術(shù)切除：膽囊息肉直徑≥10mm；膽囊息肉合并膽囊結(jié)石、膽囊炎；息肉單發(fā)或無蒂；息肉生長速度>3mm/6個(gè)月；除了以上風(fēng)險(xiǎn)較大的情況下，患者都可以采取隨訪觀察：第一次半年，然后每年復(fù)查，延續(xù)5年。除了保守觀察就沒有其他辦法了嗎？中國的內(nèi)外科專家也提出了兩個(gè)辦法：1、中醫(yī)藥治療膽囊息肉：中醫(yī)學(xué)將膽囊息肉分為3型 ①.肝郁氣滯型。右脅以脹痛 為主，疼痛常隨情志變化而增減，苔薄白，善太息或時(shí)有暖 氣，納少，脈弦； ②.痰瘀交阻型。右脅悶脹不適，口粘不渴， 或渴不欲飲，苔白膩，舌質(zhì)淡，大便無形粘膩不爽，頭昏， 脈沉或弦滑； ③.肝膽濕熱蘊(yùn)結(jié)型。右脅疼痛或脹痛不適，舌苔 黃或厚膩，舌質(zhì)紅，腹脹滿，口干、口苦，小便黃赤，大便干 結(jié)，脈弦滑或弦數(shù)。 通過中藥辨證施治，可以使膽囊息肉的生長速度減慢甚至消除息肉。2、中西醫(yī)結(jié)合內(nèi)鏡微創(chuàng)保膽取息肉：對于直徑> 大于 5mm 的膽囊息肉，排除常見惡性特征，可以考慮先微創(chuàng)保膽取息肉，然后再中西醫(yī)結(jié)合預(yù)防復(fù)發(fā)。其獨(dú)特優(yōu)勢有： ①膽道鏡下將膽囊息肉完整取出， 能夠獲得膽囊息肉的病理診斷； ②診斷的同時(shí)起到了切除病灶作用； ③保留了膽囊功能； ④中西醫(yī)結(jié)合，大大降低了膽囊良性息肉復(fù)發(fā)幾率；這下各位明白了吧？還有不清楚的，請來深圳市中醫(yī)院肝膽胰外科門診，向?qū)？漆t(yī)師咨詢。深圳市中醫(yī)院是深圳市最早開展內(nèi)鏡微創(chuàng)取石和取息肉保膽手術(shù)，我們的膽囊息肉患者，全程跟蹤，中西醫(yī)結(jié)合，復(fù)發(fā)率低，效果滿意。深圳市中醫(yī)院內(nèi)鏡微創(chuàng)保膽外科團(tuán)隊(duì)：劉嘉林主任醫(yī)師：中國醫(yī)師協(xié)會(huì)內(nèi)鏡微創(chuàng)保膽培訓(xùn)基地主任； 門診時(shí)間：星期一 上午 肝膽外科 星期四 上午 肝膽外科

時(shí)過境遷，隨著人們越來越重視體檢，很多患者就拿著診斷有肝血管瘤的體檢報(bào)告前來咨詢，不少人是談“瘤”色變，以為自己就是得了癌癥！事實(shí)上肝血管瘤跟“癌癥”毫無關(guān)系，它不是癌！是肝臟內(nèi)最常見的良性腫瘤，占肝良性腫瘤的84%，普通人群中的發(fā)病率是0.4%～20%，中年女性發(fā)病率高于男性，是男性的6倍。為什么會(huì)得肝血管瘤呢？肝臟是人體最大的血庫，它由無數(shù)個(gè)小血竇有序地排列而成。當(dāng)這些血竇因某種原因發(fā)生異常變化時(shí)，就形成了所謂的“血管瘤”。肝血管瘤的病因目前還沒有完全明確，先天性血管竇發(fā)育異常可能是大多數(shù)肝血管瘤發(fā)生的主要原因，這類患者大部分有家庭遺傳傾向。另外，由于大部分肝血管瘤發(fā)生在女性身上，故肝血管瘤的發(fā)生與女性激素也有一定關(guān)系。有哪些癥狀呢？ 一般情況上，肝血管瘤缺乏明顯的癥狀，大多數(shù)人都只是在體檢或者其他原因檢查肝臟時(shí)被發(fā)現(xiàn)。但當(dāng)肝血管瘤的瘤體較大時(shí)，可引起上腹不適、腹痛、腹脹等胃腸道激惹的表現(xiàn)。如巨大血管瘤會(huì)壓迫胃腸，引起上腹飽脹、墜脹和壓迫感，從而導(dǎo)致進(jìn)食減少。怎樣診斷呢？肝血管瘤往往是通過影像學(xué)檢查確診，B超為首選的檢查方法。較小肝血管瘤多表現(xiàn)為邊界清晰的強(qiáng)回聲占位，較大肝血管瘤則表現(xiàn)為邊界清晰、內(nèi)部回聲雜亂、強(qiáng)弱不均。另外，核磁共振對肝血管瘤具有特殊的診斷價(jià)值，“燈泡征”樣信號為其特征性表現(xiàn)。增強(qiáng)CT顯示出“早出晚歸”征亦是肝血管瘤的特征性表現(xiàn)。肝血管瘤需要治療么？大多數(shù)肝血管瘤是不需要治療，但需要每半年到一年復(fù)查一次。根據(jù)全國專家共識的意見，符合以下情況就要需要盡早治療：1.有肝炎病史，瘤體較小，無法與小肝癌相鑒別；2.瘤體較大（直徑>5cm）、發(fā)展速度快或已導(dǎo)致明顯不適（如腹脹、腹痛）或肝功能受損；3.巨大肝血管瘤（直徑≥10 cm）影響肝功能，導(dǎo)致凝血功能障礙、血小板減少和低纖維蛋白原血癥；4.長在肝臟表面，與膈肌、腹壁粘連，有高度出血風(fēng)險(xiǎn)的；那么肝血管瘤要如何治療呢？且聽下回分解…

What should I do if I have gallstones? The only public recognized way is to remove the gallbladdertogether withstones surgically! For gallstones without any symptoms, some doctors will recommend " observefirst, surgery shouldbe put off." In fact, gallstoneswillcause acute cholecystitis and continuousdamaging the gallbladder mucosa,whichmay inducegallbladder carcinogenesis.Gallstonescanalsoslideintothe common bile ductand contributeacute cholangitis,evenfatalpancreatitis.The traditional surgical procedure is to remove the gallbladder,which is calledcholecystectomy,to take out the stone with the gallbladdersimultaneously. Doctors should emphasize that the process of cholecystectomy,no matterlaparotomy or laparoscopy, hardly completely avoid various corresponding surgical complications,includingbile duct injury, bile leakage,andintestinal injury. Moreover, there may besomepostoperative sequelaesafter cholecystectomy, such as dyspepsia, bile reflux gastritis, duodenal papillary dysfunction, post-cholecystectomy syndrome, digestive tract tumors, etc.To minimize these surgical risks orsequelaeswhich caused by the removal of the gallbladder, the Department of Hepatobiliary Surgery leadbyDirector Liu Jialin，practiceminimally invasive surgery toremovegallstoneswithout cholecystectomy, which called LaparoscopicCholedochoscopic Gallbladder-Preserving Cholecystolithotomy (L-CGPS). This is a new concept for the treatment of gallstones in recent years. Simply cuttinga small incisiononthe gallbladder, then remove the gallstonesby endoscope. At last, the gallbladder incision is sutured. Therefore, the stones are moved, but the gallbladderand it's functionwouldbe preservedundoubted. The surgeon should be skill-full because the procedure is rather complex.Even it is not a straightforward operation, the operation ofL-CGPSstill holds various of advantages. The biggest benefit, of course, is tosavethe gallbladder. Human evolution leaves the small spherical organ of the gallbladder for three million years. It not only plays a role in storing and concentrating bile, but also plays an important role in human bile acid hepatoenteral circulation and gut immune function. Compared with cholecystectomy, the operation ofL-CGPSbarelydamage the function of the gallbladder. Additionally, the risk of this surgery is small and the incidence of complications are comparatively low. Gastric tubeor urinary catheteris unnecessary generally. Patients are usually able to get off wardbeds, takewater and liquid diet on the day after their surgeries. On the next day after surgery, they can be discharged home.Today, the biggest problem with the operation of L-CGPS is the recurrence of gallstones. The probability of recurrence of stones after surgery in China is about 8%, which requires long-term medication (6~12 months) to minimize it.Many patients who underwentL-CGPSsuccessfully in ourhospitalare very healthy now. They feel relaxing and pleasant, and are enjoying a wonderful life.Postoperative follow-up and health guidance are essential for patients who have undergone gallstone removalwithoutcholecystectomy. Doctor Liu Jialin arranged the doctors of the department to understand the history, family history, diet and other work of each patient to process them privately-made "health prescriptions", which covers postoperative medication, daily routine, eating habits, etc. Through doctors' hard work, the risk of recurrence is minimized.As a pioneer in the operation of laparoscopiccholecystolithotomy in Shenzhen, hepatobiliary surgery in our hospital strives to be in the forefront of the country in the medical and scientific research of laparoscopiccholecystolithotomy.The general public is welcome to our hospital for hepatobiliary surgery consultation. We will relieve your gallbladder problemwith our most sincere service！Hepatobiliary Surgery Experts of Gallbladder-PreservingOperation Shenzhen Third People's HospitalLiu Jialin（劉嘉林） Each Monday Morning8:00~12:00;Tian Hengyu（田恒宇） Each Wednesday Morning 8:00~12:00and Thursday Afternoon 14:00~17:00;Xie ZhuoZhao（謝卓朝） Each Tuesday Afternoon14:00~17:00;