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。

Diagnosis and Surgical Treatment of Xanthogranulomatous Cholecystitis(A Report of 25 Cases)

Objective To investigate diagnosis and surgical treatment of xanthogranulomatous cholecystitis(XGC).Methods The clinical data of 25 patients with pathologically diagnosed XGC admitted during Jan.2001 and May.2009 were retrospectively analyzed.Results The 25 patients did not have definite preoperative diagnosis,and all the patients were examined by B-Ultrasound,17 by CT,5 by MRI.3 patients were misdiagnosed as having gallbladder cancer,22 patients having cholecystolithiasis with cholecystitis.According to the intraoperative findings: thickening of the gallbladder wall was found in all patients,peri-gallbladder invading of Xanthogranulomatous tissue was found in 23 patients,coexistence of cholecystolithiasis was present in 22 patients,Mirizzi syndrome was observed in 4 patients,4 patients were complicated by gallbladder fistula.Open cholecystectomy was performed in 13 patients,greater partical cholecystectomy were undertaken in 4 patients.In addition,cholecystectomy and duodenal fistula repair were undertaken in 3 patients,radical resection of gallbladder cancer in 2 patients,common bile duct exploration and T tube drainage in 2 patients,colectomy in 1 patient.17 of the patient confirmed diagnosis by frozen section pathological examination during operation.All patients were confirmed with definite diagnosis by pathological examination.2 patients suffered from bile leak and 5 patients from incision infection.Conclusion XGC is a rare and special type of chronic cholecystitis,which is difficult to be diagnosed preoperatively,and is very likely to be diagnosed as gallbladder cancer.Definite diagnosis of XGC depends on pathological examination.The basic method of treatment is cholecystectomy.