Cholecystic protuberant lesions

　　The etiology of cholecystic protuberant lesions, also known as cholecystoma polyps, is not yet clear. Pathologically, gallbladder polyps belong to papillary adenomas and can be divided into two types: cholesterol polyps and inflammatory polyps. The former is due to high gallbladder pressure or abnormal cholesterol metabolism, leading to cholesterol granules precipitating in the basal layer of mucosal epithelial cells, causing excessive expansion of tissue cells; some scholars believe that it is due to macrophages on the mucosa phagocytizing cholesterol crystals and accumulating; the latter is due to tissue interstitial glandular epithelial hyperplasia caused by inflammation stimulation, and formed by a large number of inflammatory cells, mainly lymphocytes and monocytes. Cholecystoadenoma belongs to one of the gallbladder proliferative lesions and is due to hyperplasia and thickening of the gallbladder mucosa. The number of Rokitansky-Aschoff sinuses increases and expands into cystic sacs, penetrating into the deep muscle layer, with channels connecting the sinus and the gallbladder lumen, forming pseudodiverticula.

　　In addition to general symptoms, cholecystic protuberant lesions can also cause other diseases. This disease often complicates with cholecystitis, cholelithiasis, and even polypoid gallbladder cancer. Therefore, once discovered, it requires active treatment, and preventive measures should also be taken in daily life.

　　Cholecystic protuberant lesions, also known as cholecystoma polyps, occur between the ages of 23 to 55 years, with more males than females. Patients generally have mild symptoms, even asymptomatic, and may only be discovered to have lesions in the gallbladder during accidental ultrasound examinations. A few patients may experience upper abdominal discomfort, nausea and vomiting, decreased appetite, and may be accompanied by abdominal pain, located in the upper right abdomen or right hypochondrium, with radiation to the right shoulder and back, without fever and jaundice. It can also cause jaundice, cholecystitis, biliary hemorrhage, pancreatitis, and other diseases. Long pedunculated polyps located at the neck of the gallbladder can cause biliary colic, and acute attacks may occur during inflammation and infection.

　　To prevent cholecystic papillary lesions, it is necessary to overcome unhealthy lifestyle habits, have regular meals, and adhere to a low-cholesterol and low-fat diet.

　　1. Meals should be regular

　　Patients should have a good breakfast. Bile in the gallbladder has the function of digesting food. If patients do not have regular meals, especially not eating breakfast, the bile secreted by the gallbladder will not be utilized, leading to the bile staying in the gallbladder for too long, thereby stimulating the gallbladder to form gallbladder polyps or causing the existing polyps to increase or increase in number.

　　2. Adhere to a low-cholesterol and low-fat diet

　　Excessive intake of cholesterol not only increases the burden on the patient's liver but can also cause excess cholesterol to crystallize, accumulate, and precipitate on the gallbladder wall, thus forming gallbladder polyps. Therefore, patients should reduce their intake of cholesterol, especially avoid high-cholesterol foods in the evening, such as eggs, animal internal organs, scaleless fish, seafood, and fatty meat.

　　3. To ensure a healthy lifestyle

　　Patients need to overcome unhealthy lifestyle habits, quit smoking and drinking, avoid staying up late, maintain a good mental state, regularly participate in physical exercise to enhance physical fitness, and enhance the body's ability to resist diseases. If necessary, you can also make tea with hawthorn, chrysanthemum, cassia seed, and other herbs for frequent consumption to achieve the purpose of reducing cholesterol.

　　Patients with cholecystic papillary lesions should undergo ultrasound, CT, cholecystography, and other examinations.

　　First, Ultrasound

　　1. Ultrasound diagnosis is sensitive and accurate, can be repeated, and is the preferred diagnostic method for biliary tract diseases. The gallbladder wall prominence is usually a benign echo, while a low echo is more common in malignant cases. It can be seen that ultrasound can improve the diagnostic rate of benign and malignant pathological typing of gallbladder polyps.

　　2. Ultrasound is a simple and easy-to-use examination method with high accuracy, no pain, no injury, and relatively economical. It can avoid the delay and blindness of surgery. However, there are certain limitations and false-negative rates in the diagnosis, classification, and differential diagnosis of this disease by ultrasound. For example, when the lesion is small and located at the neck of the gallbladder, or accompanied by gallstones, it is easy to cause missed diagnosis, and there are also certain difficulties in classification and differentiation.

　　Second, Cholecystic CT

　　CT has high resolution, and the contrast agent for biliary tractography is injected intravenously to show clearer images, which is helpful for accurate diagnosis and evaluation of surgery. However, CT has certain limitations and cannot detect diameters of

　　Patients with cholecystic papillary lesions, in addition to general treatment, need to pay attention to their diet.

　　1. It is advisable to consume a variety of fresh fruits and vegetables, and low-fat, low-cholesterol foods such as mushrooms, wood ear, celery, sprouts, kelp, lotus root, fish meat, rabbit meat, chicken meat, fresh beans, and so on.

　　2. Prefer to eat more dried beans and their products.

　　3. Prefer vegetable oils and do not use animal oils.

　　4. When drinking water, squeeze a little hawthorn, sea buckthorn, ginkgo, and Polygonum multiflorum herb into the cup and drink it as tea.

　　5. Eat more foods rich in vitamin A, such as green vegetables, carrots, tomatoes, Chinese cabbage, spinach, chives, corn, radishes, and so on.

　　6. Eat less spicy food such as chili, raw garlic, and other irritant foods or spicy foods.

　　7. Avoid eating high-cholesterol foods such as eggs (especially yolks), fatty meat, seafood, non-scaled fish, animal internal organs, and other foods.

　　7. Abstain from alcohol and alcoholic beverages. Alcohol is mainly metabolized and detoxified by the liver in the body, so alcohol can directly damage liver function, cause liver and gallbladder dysfunction, disrupt the secretion and excretion process of bile, and thereby stimulate the formation of new polyps or cause the growth and enlargement of existing polyps.

　　Gallbladder papillary lesions, also known as gallbladder polyps, this disease can have no clinical manifestations unless it causes cholecystitis. Surgical treatment usually adopts cholecystectomy, and in addition to traditional large incision resection, laparoscopic cholecystectomy and mini-invasive cholecystectomy are currently more widely used, as well as cholecystectomy for polyps.

　　1. Laparoscopic cholecystectomy:It has the advantages of even less trauma and faster recovery. The experience of foreign countries summarizes the surgical indications as the gallbladder and surrounding tissue have no severe adhesions and there are no other contraindications.

　　2. Mini-invasive cholecystectomy:Mini-invasive cholecystectomy can avoid the many disadvantages of large incision surgery and has obvious effects. The application range of mini-invasive surgery is wide, and it is feasible to perform a cholangiogram, stone extraction, and drainage for patients with thin abdominal walls, and it has the characteristics of less postoperative pain, fast recovery, and fewer complications. Therefore, mini-invasive cholecystectomy has the advantages of less trauma, fast recovery, and low incidence of complications.

　　3. Cholecystectomy for polyps:If the patient wishes to retain the gallbladder and is under 60 years old and meets the standards for preventive cholecystectomy, a laparoscopic cholecystoscopy combined with cholecystectomy and biopsy can be tried for this group of patients, and the decision to remove or retain the gallbladder will be made according to the pathological nature of the polyps during surgery. This can maximize the retention of part of the patients' gallbladders.