黄色肉芽肿性胆囊炎的临床诊断及治疗

目的探讨黄色肉芽肿性胆囊炎（XGC）的诊断与治疗。方法回顾性分析近五年来我科收治的9例XGC病人的临床资料。结果术前B超检查9例，CT检查4例，MRI检查3例，行ERCP检查1例，术前均误诊，术中冰冻病理确诊7例，术后石蜡病理确诊9例。5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例行胆囊大部切除加十二指肠瘘修补术，2例行胆囊切除加胆囊床部肝组织切除。术后并发胆瘘1例，切口感染1例。本组无死亡病例。结论XGC是一种少见特殊类型的胆囊慢性炎性疾病，术前难与胆囊癌相鉴别，目前认为XGC与胆囊癌可能有关。因此，XGC一经诊断应积极手术治疗，术中冰冻切片检查、术后病理检查是关键，XGC仅需行胆囊切除，不宜盲目扩大切除的范围。

Probe of diagnosis and treatment for xanthogranulomatous cholecystitis

Objective To probe into the diagnosis and treatments for XGC. Methods To review the clinical data of 9 patients with XGC. Results 9 patients were examined with B - urtral sound. 4patients were re - examed with CT and 5 patients were re-examed with MRI. One patient was examed with ERCP. All patients were misdiangnosed befor operation, while all were diagnosed definitly through pathological examination and 7 of 9 cases were diagnosed by operative freezing section. Total cholecystectomy was executed in 5 patients. In addition to Partial cholecystectomy 1 case executed cholecystoduodenal fistula neoplasty. Besides cholecystectomy, 1 case was executed exploratory choledochostomy and T tube dra!nage, 2 cases were executed with partial liver wedge resection beneath gallbladdler bed. 1 case suffered from bilary leak, one incision infection. All patients were cured and no mortality. Conclusions XGC is a rare and special type chronic cholecystitis. It is liable to be confused with cholecyst carcinoma preoperation. Definite diagnosis depends on pathological examination. The optimal means of diagnosis and treatment is cholecystectomy operation in which intra operative freezing section is critical. Randomly magnified operation should be avoided.