Safra kesesi poliplerinde cerrahi deneyimimiz
Our surgical experience in gall bladder polyps
Yazar: Dinç, Tolga; Coşkun, Faruk; Küçük, Kutlu Özlem
Dergi: Gaziantep Medical Journal, Vol. 19 No. 3, 2014
Anahtar kelimeler: Cholecystectomy; polyp; gall bladder ; Kolesistektomi; polip; safra kesesi

Çalışma; Ankara Numune Eğitim ve Araştırma Hastanesi 3. Genel Cerrahi Kliniğine, Mayıs 2005 ile Haziran 2011 tarihleri arasında safra kesesi polibi tanısı almış, verilerine ulaşılan 59 hastadan opere edilen 35 hastanın retrospektif analizini içermektedir. Klinikte safra kesesi polibi tanısı ile opere edilen 35 hastanın 21'i (%60) kadın; 14'ü (%40) erkekti. Ortalama yaş 47.1 idi. Tüm olgularda radyolojik tetkik olarak ultrasonografi kullanıldı. Hastaların preoperatif dönemde yapılan ultrasonografilerinde; 14 (%40) olguda tek polip; 7 (%20) olguda multipl polip; 13 (%37.2) olguda polip ve safra kesesi taşı; 1 (%2.8) olguda malignite açısından şüpheli bulgulara rastlandı. Otuz beş hastadan; 32'sine (%91.5) laparoskopik kolesistektomi, 3'üne (%8.5) ise açık kolesistektomi uygulanmıştır. Hitopatolojik incelemede; 19 hastada kollesterol polibi; 13 hastada kolesterol polibi + kolelitiazis, 1 hastada adenomatöz polip, 1 hastada safra kesesi adenokanseri saptanmıştır. Polip tanısı ile opere edilen 1 hastanın patolojik incelemesinde polip saptanmamış ve safra kesesi duvarına yapışık 1 adet safra taşı izlenmiştir. Sonuç olarak, semptomatik olmasa bile 50 yaş üzerinde, polip boyutu 10 mm üzerinde olan, kolelitiazis ile birlikte olan olgularda malignite ihtimali olduğundan dolayı cerrahi tedavi uygulanmalıdır. Bunların dışında 10 mm'nin altında olan olgular 6 aylık periyotlarla ultrasonografi izlem programına alınmalıdırlar. Bu zaman zarfında polip boyutlarında büyüme, polip sayılarında artış olursa, semptomlar gelişirse cerrahi tedavi gündeme getirilmelidir.

Our study includes the retrospective analysis of 35 patients who were operated with the diagnosis of gallbladder polyp, between May 2005 and June 2011 at Ankara Numune Training and Research Hospital, 3rd Department of General Surgery. In this period 59 patients were diagnosed by gallbladder polyps, but only 35 of them were operated. Twenty one of 35 patients who were operated in our clinic with the diagnosis of gallbladder polyps, were female (%60) and 14 were male (40%). The mean age was 47.1. In all cases, ultrasound is used as a radiological examination. According to the preoperative ultrasonography reports of the patients; in 14 (40%) cases there was a single polyp, in 7 (20%) cases there were multiple polyps, in 13 (37.2%) cases there were polyps and gallstones and in 1 (2.8%) case his findings were suspicious for malignancy. We performed laparoscopic cholecystectomy to 32 (91.5%) of 35 patients and 3 patients (8.5%) were performed open cholecystectomy. According to histopathological examination, cholesterol polyps in 19 patients, cholesterol polyps + cholelithiasis in 13 patients, adenomatous polyp in one patient, and adenocarcinoma of the gallbladder in one patient were found. During the pathological examination of a patient who was operated with the diagnosis of polyp; there was no polyp detected, and a gallstone adherent to the gallbladder wall was observed. As a result, even if there is no symptom, surgical treatment must be performed to the patients over 50 years of age, with a polyp size over 10 mm, and with cholelithiasis, because of the possibility of malignancy. The cases with polyp size under 10 mm must be followed up with a 6 months period by ultrasonographic examination. During this time; surgery must be considered if there is an increase in polyp size and number of polyps or symptoms were developed.