黄色肉芽肿性胆囊炎16例临床病理分析

黄色肉芽肿性胆囊炎（XGC）是一种少见的慢性胆囊炎的特殊类型,是以胆囊壁的纤维组织增生以及泡沫样组织细胞浸润为特征的肉芽肿性炎症。因其临床及影像学表现均缺乏特异性,而难与胆囊炎、胆石症区分,当与周围组织粘连或形成肿块时又难与胆囊癌区分,故术前诊断率偏低。本文对经病理确诊的16例XGC进行临床病理分析,旨在提高对本病的认识,确保XGC的诊断,避免误诊、漏诊。     

黄色肉芽肿性胆囊炎16例临床病理分析

黄色肉芽肿性胆囊炎(XGC)是一种少见的慢性胆囊炎的特殊类型,是以胆囊壁的纤维组织增生以及泡沫样组织细胞浸润为特征的肉芽肿性炎症.因其临床及影像学表现均缺乏特异性,而难与胆囊炎、胆石症区分,当与周围组织粘连或形成肿块时又难与胆囊癌区分,故术前诊断率偏低.本文对经病理确诊的16例XGC进行临床病理分析,旨在提高对本病的认识,确保XGC的诊断,避免误诊、漏诊.     

慢性黄色肉芽肿性胆囊炎临床及病理分析

目的探讨黄色肉芽肿性胆囊炎(XGC)的临床、超声和病理特征,以提高诊治水平。方法回顾性分析46例确诊病例的临床资料。结果黄色肉芽肿性胆囊炎临床表现与普通慢性胆囊炎相似。胆囊壁不同程度增厚破坏,内壁可见黄色或者棕色斑块。镜下为纤维母细胞,泡沫样组织细胞,急慢性炎细胞组成的肉芽肿改变。结论临床上较难区分黄色肉芽肿性胆囊炎和胆囊癌,确诊必须依靠病理检查。     

黄色肉芽肿性胆囊炎23例临床病理分析

目的探讨黄色肉芽肿性胆囊炎(xanthogranulomatous cholecystitis,XGC)的临床病理特点及诊断要点。方法回顾性分析23例XGC患者的临床与病理资料。结果 23例XGC均为老年人,女性多见。临床表现类似一般的胆囊炎或胆石病,所有患者术前均误诊为胆囊炎或胆囊癌。XGC病变多位于胆囊体部,病理学检查是在胆囊壁内形成特征性泡沫状细胞性肉芽肿,术后病理诊断为XGC。结论 XGC临床症状不典型,常在术前难以诊断,极易造成误诊,应引起高度重视。     

黄色肉芽肿性胆囊炎46例诊治分析

目的 探讨黄色肉芽肿性胆囊炎(XGC)的临床诊断与治疗.方法 回顾性分析病理确诊为黄色肉芽肿性胆囊炎的46例临床资料.结果 术前诊断为XGC为20例,准确率为43.47％.CT及MRI对XGC的诊断有效率远远大于B超.临床治愈45例,1例术后发生门静脉栓塞死亡.结论 XGC是一种少见的特殊类型的慢性胆囊炎,术前诊断依靠临床表现及影像学检查,诊断的准确率有所提高,但确诊仍依赖病理检查.术式以腹腔镜胆囊切除术(LC)为主,手术范围以尽可能的切除病变胆囊为主.     

手术治疗黄色肉芽肿性胆囊炎疗效分析

目的：探讨黄色肉芽肿性胆囊炎（XGC）的诊断和治疗。方法回顾性分析1998年1月至2012年12月确诊的26例黄色肉芽肿性胆囊炎患者的临床资料。结果术前B超检查26例,CT检查12例,术前诊断为慢性结石性胆囊炎22例,胆囊癌4例。18例行胆囊切除术、4例胆囊切除术加胆总管探查T管引流术、2例行胆囊切除术加十二指肠瘘修补术、2例行胆囊切除加胆囊床肝组织楔形切除术。26例患者术后病理检查均确诊为XGC。所有病例均治愈,无死亡病例。结论 XGC是一种特殊类型的胆囊炎,术前难以诊断,确诊需依赖病理检查,胆囊切除术是基本手术方式。     

黄色肉芽肿性胆囊炎的病理诊断、腹腔镜胆囊切除术及护理

[目的]探讨黄色内芽肿性胆囊炎(XGC)病理诊断、腹腔镜胆囊切除术(LC)及护理对策.[方法]回顾分析1998年1月-2007年12月治疗XGC 64例的临床资料,进行临床表现、组织形态学、免疫组织化学的观察研究及手术前后护理,对其诊断、发病机制和护理对策进行探讨,比较腹腔镜与开腹手术在手术时间、术后住院天数方面的差别.[结果]XGC临床表现缺乏特异性.胆囊壁不同程度增厚,切面常见淡黄色大小不等的结节或斑块,有的有蒂呈息肉样隆起.胆囊壁的正常结构受到不同程度的破坏,出现特征性的黄色肉芽肿结构即大量吞噬脂质的泡沫样组织细胞及增生的成纤维细胞,并可见大量淋巴细胞、单核细胞及中性粒细胞浸润.免疫组织化学染色泡沫样细胞及巨噬细胞AAT(+)、CD68(+);胆囊黏膜及R-A窭上皮EMA(+),CK(+),CEA(-).腹腔镜组的手术时间、住院天数明显短于开腹组.[结论]XGC是一种良性而有破坏性的特殊类型胆囊炎,主要表现为胆囊壁不同程度增厚,常伴有胆囊结石或胆管结石,临床诊断困难,确诊有赖于病理诊断,LC可作为治疗XGC的首选方法,高质量的护理是LC成功的重要环节,要给予高度重视.     

黄色肉芽肿性胆囊炎CT和病理特征

【目的】探讨黄色肉芽肿性胆囊炎（XGC）的CT和病理特征。【方法】回顾性分析经手术病理证实的13例XGC患者的CT影像学和病理学资料。【结果】13例XGC均表现为胆囊壁不同程度增厚,增强扫描增厚的胆囊壁轻一中度强化,n例增厚的胆囊壁内见条片状、结节状低密度影,增强扫描低密度影均无明显强化;7例囊内壁光整,黏膜线连续;6例黏膜面毛糙,不完整;13例胆囊内见均见结石,4例累及肝脏,5例与周围肠管粘连、分界不清;13例病理特点均表现为胆囊壁特征性的黄色肉芽肿结构,主要为泡沫样组织细胞,大量纤维组织增生,伴有淋巴细胞和浆细胞浸润,6例黏膜糜烂、渍疡形成。【结论】XGC的CT表现及病理具有一定的特征性,CT检查有助于XGC的诊断。     

18例黄色肉芽肿性胆囊炎的临床分析

目的 探讨黄色肉芽肿性胆囊炎（XGC）的临床诊断与治疗.方法 回顾性分析经病理确诊的18例XGC患者的临床资料.结果 术前B超检查18例,CT检查3例,MRI检查1例,ERCP检查l例,术中快速冷冻病理确诊9例.10例行胆囊切除术,1例行胆囊切除加胆总管探查T管引流术,1例因伴慢性胰腺炎行胆囊切除加胰头囊肿十二指肠引流术,6例行LC术,其中4例中转开腹.均治愈,无死亡病例.结论 XGC是一种少见的特殊类型的慢性胆囊炎,术前诊断困难,且极易误诊为胆囊癌,确诊依赖病理检查.开腹胆囊切除是基本手术方式.     

黄色肉芽肿性胆囊炎的临床诊断及手术治疗：附25例报告

目的总结黄色肉芽肿性胆囊炎（xanthogranulomatous cholecystitis,XGC）的诊治经验。方法回顾性分析我院2001年1月～2009年5月25例经病理确诊为XGC的临床资料。结果 25例术前均未明确诊断,行B超检查25例,CT检查17例,MRI检查5例,术前诊断为胆囊癌3例,胆囊炎、胆囊结石22例。术中见所有病例胆囊壁明显增厚,23例与周围组织粘连致密,22例合并胆囊结石,4例合并Mirizzi综合征,4例合并有胆囊内瘘。13例行单纯胆囊切除术,4例行胆囊大部分切除术,3例行胆囊切除及十二指肠修补术,2例行胆囊切除、肝部分楔形切除、肝门部淋巴结清扫,2例行胆囊切除、胆总管探查引流术,1例行胆囊切除、结肠部分切除术。术中经冷冻切片病理检查确诊XGC 17例;余8例中,6例诊断为急性胆囊炎,2例诊断为慢性胆囊炎急性发作,胆囊癌不能排除,术后病理检查均诊断为XGC。术后并发胆漏2例,切口感染5例。结论 XGC是一种特殊类型的胆囊慢性炎症,临床非常少见,术前诊断比较困难,术中易诊断为胆囊癌,病理检查是XGC的诊断关键,胆囊切除是基本治疗方法。     

Endoscopic sonography in the diagnosis of xanthogranulomatous cholecystitis.

Xanthogranulomatous cholecystitis (XGC) is an unusual inflammatory disease of the gallbladder that may simulate gallbladder cancer. We report the findings with conventional sonography, endoscopic sonography (EUS), and CT in 3 cases of XGC. EUS could visualize hyperechoic nodules in the gallbladder wall, probably representing xanthogranulomas, but loss of the multilayered structure of the gallbladder wall and infiltration into adjacent organs make differentiating XGC from gallbladder cancer difficult with EUS alone.     

黄色肉芽肿性胆囊炎的影像学表现

目的探讨黄色肉芽肿性胆囊炎的影像学表现及其病理基础。方法分析经病理证实的16例黄色肉芽肿性胆囊炎的CT、MR表现。观察胆囊壁厚度、胆囊壁强化情况、胆囊壁内结节、胆囊内黏膜线、胆囊内有无结石以及胆囊周围的变化。结果16例患者中胆囊增大12例、缩小4例,所有患者均见不同程度的胆囊壁增厚及胆囊壁内结节,6例胆囊内显示黏膜线。11例患者胆囊内有结石。胆囊周围炎性浸润8例,其中2例炎症侵及肝脏。结论胆囊壁增厚、增厚胆囊壁内结节及胆囊内黏膜线是诊断黄色肉芽肿性胆囊炎的特征性表现。     

Failed or difficult laparoscopic cholecystectomy: Can preoperative ultrasonography identify potential problems?

A prospective study was performed to assess the role of preoperative ultrasonography in predicting failed or difficult laparoscopic cholecystectomy. Fifty patients underwent detailed preoperative ultrasound examinations. The number and size of calculi, evidence of acute or chronic cholecystitis, gallbladder morphology, and the presence or absence of aberrant anatomy were documented. A comparison was made of the surgical outcome and the ultrasound findings in each patient. Six patients were converted to open cholecystectomy because of inflammatory changes in the gallbladder. The preoperative ultrasound studies in 5 of these patients demonstrated evidence of cholecystitis and cholelithiasis. Gallbladder wall thickening and contraction were also seen. Five gallbladder resections had intraoperative difficulties; preoperative ultrasonography demonstrated a thickened gallbladder wall in 2. Of 31 uneventful cases, 7 had evidence of gallbladder wall thickening and/or contraction. There were no ultrasound features that identified between the unsuccessful, difficult, or uneventful laparoscopic cholecystectomies. We conclude that detailed preoperative ultrasound evaluation of the gallbladder in patients destined for laparoscopic cholecystectomy is of little value in screening for difficult or unsuitable cases. © 1994 John Wiley & Sons, Inc.     

黄色肉芽肿性胆囊炎(附16例分析)

目的： 本文回顾性分析１６ 例黄色肉芽肿性胆囊炎 （ＸＧＣ） 的临床表现、超声特点及手术和病理结果。方法： １６ 例ＸＧＣ （男６ 例, 女１０ 例, 年龄 ４３～７８ 岁） 术前均经超声检查。结果： １６ 例ＸＧＣ 均合并胆囊结石, 胆囊壁均见增厚 ４ｍ ｍ ～１５ｍ ｍ , 其中１ 例合并肝浸润以致胆囊壁与肝实质无法分界。结论： ＸＧＣ 是一种良性慢性胆囊炎, 可能发展成胆囊癌, 尽管在组织学上具有特征, 但是在超声上无明显特异性。     

The diagnosis of cholecystitis by ultrasonic densitometry

Ultrasound densitometry was used to determine echo density of the wall and contents of the gallbladder in normal persons and in patients suffering from cholelithiasis and chronic calculus-free cholecystitis. In patients with cholelithiasis, the gallbladder was later removed, followed by histological examination of its wall. The ultrasound and histological data were studied and compared. The highly significant differences in the echo density of the wall and contents of the gallbladder were obtained in normal persons and patients afflicted with chronic cholecystitis.     

黄色肉芽肿性胆囊炎的CT表现

目的探讨黄色肉芽肿性胆囊炎(XGC)的CT表现特点,提高对XGC的诊断水平.方法回顾性分析经手术病理证实的29例XGC的CT检查资料.结果术前诊断为胆囊癌15例,慢性结石性胆囊炎14例.29例均有不同程度的胆囊壁增厚,其中局限性胆囊壁增厚8例,弥漫性胆囊壁增厚21例;增厚的胆囊壁内见单发或多发低密度结节15例;伴发胆囊结石26例;肝-胆界面较清楚者24例,肝-胆界面不清者5例;增强后增厚的胆囊壁在动脉期仅有轻度强化,门脉期至延迟期强化逐渐明显,胆囊壁内低密度结节影强化不明显,增强后显示密度较高的黏膜线9例.结论增强后增厚的胆囊壁延迟强化,增厚的胆囊壁内低密度结节,胆囊轮廓及黏膜线的存在对本病诊断有意义.     

Xanthogranulomatous cholecystitis: a radiological study of 12 cases and a review of the literature

Background: Twelve cases of xanthogranulomatous cholecystitis (XGC) are presented, and their radiologic appearance is described. Methods: Four men and eight women, aged 31–82 years old, with XGC were reviewed. Abdominal ultrasound (US) was performed in all patients. Computed tomography (CT) was performed in five patients, barium enema examination in two, and percutaneously CT-guided fine-needle aspirative biopsy of the gallbladder in one. Results: Barium enema examination showed an indentation of the hepatic flexure. Cholelithiasis was present in all patients, and sludge was present in six. The gallbladder wall was thickened in all patients, irregular in nine, and could not be properly differentiated from surrounding liver parenchyma or from other adjacent structures in most patients. A curvilinear halo, hypoechoic on US and with low attenuation on CT, within the gallbladder wall was found in three patients and pericholecystic fluid in two others. On CT, the pericholecystic fat had streaky soft tissue densities in three cases. Percutaneously CT-guided fine-needle aspirative biopsy of the gallbladder was nondiagnostic. The diagnosis of gallbladder carcinoma was considered preoperatively in three patients. Conclusion: Despite the characteristic histologic appearance of XCG, radiologic findings are nonspecific, varying from signs observed in other forms of cholecystitis to the appearance of a gallbladder neoplasm. Received: 5 April 1995/Accepted: 15 May 1995     

黄色肉芽肿性胆囊炎的MRI表现特点

目的：探讨黄色肉芽肿性胆囊炎（Xanthogranulomatous cholecystitis,XGC）的MRI影像表现特点。方法：回顾性分析15例经病理证实为XGC的患者的术前MRI影像。观察胆囊本身改变（壁增厚的方式和程度、信号特点、黏膜线是否完整、强化程度及是否有结石）、胆囊周围脂肪及肝实质的改变。结果：15例患者均出现胆囊壁增厚,范围为0.8~2.6cm,其中13例为弥漫性增厚,2例为局灶性增厚。13例弥漫性增厚的病例中均匀性增厚2例,不均匀增厚11例。10例患者出现胆囊壁内结节,大小为0.2~0.7cm,表现为较长T1、长T2信号,增强扫描未见确切强化。15例患者均表现为黏膜线显著强化,其中黏膜线完整11例,中断4例。合并胆囊结石15例。所有病例均出现肝实质动脉期一过性强化,邻近肝实质出现肝脓肿7例,与十二指肠粘连6例。结论：胆囊壁不均匀增厚、壁内出现结节、黏膜线完整并明显强化、邻近肝实质动脉期一过性强化是XGC较常见的影像表现,并符合其病理特点。