黄色肉芽肿性胆囊炎与胆囊结石的关系

目的研究黄色肉芽肿性胆囊炎（XGC）与胆囊结石的关系，探讨胆囊结石在XGC发病中的作用。方法回顾性分析1996年1月至2005年12月33例经病理确诊为XGC的临床资料。结果33例均行B超检查，其中20例行CT检查。全部行手术治疗。术中发现合并胆囊结石32例，单发胆囊结石ll例，多发胆囊结石21例。26例胆囊结石直径≥1．0cm；20例结石位于胆囊颈部，占所有合并胆囊结石病例的62．5％。此外，5例合并胆总管结石，3例合并Mirizzi综合征，无一例合并肝内胆管结石。结论XGC是一种特殊类型的慢性胆囊炎症，伴有黄色肉芽肿形成，重度增生性纤维化，以及泡沫状组织细胞为特征，临床上非常少见，术前诊断困难。需依赖病理检查确诊。几乎所有的XGC均合并胆囊结石。胆囊结石会引起胆汁淤积，使胆汁渗入破损的胆囊壁，从而可能引起XGC的发生。胆囊颈部结石嵌顿很可能在XGC的发病中起着重要作用。

The relationship between xanthogranulomatous cholecystitis and cholecystolithiasis

Objective To study the relationship between xanthogranulomatous cholecystitis (XGC) and cholecystolithiasis,and to investigate the effect of cholecystolithiasis on the pathogenesis of XGC.Methods The clinical data of 33 patients with XGC diagnosed definitely by pathological examination over a period of 10 years were analyzed retrospectively.20 were men and 13 were women.Results Abdominal ultrasonography was performed in all patients,and computed tomography (CT) in 20 cases.In the operations of all patients,XGC was associated with cholecystolithiasis in 32 patients (97%),which quantity,size,and quality varied from person to person.Among these 32 patients,11 patients were XGC with solitary gallbladder stone,and 21 patients with multiple gallbladder stones;26 patients had gallbladder calculus which diameter were more than 1.0 cent;and 20 patients (62.5%) had impacted stones in neck of gallbladder.In addition,15.2% of all were associated with choledocholithiasis,Mirizzi syndrome was observed in 9.1% of the patients, and no one was associated with intrahepatic bile duct stone.Conclusion XGC is a rare and special type of chronic cholecystitis associated with Xanthogranuloma,proliferative fibrosis and foam cells,which is difficult to be diagnosed preoperatively.Definite diagnosis depends on pathological examination.Gallbladder stones could result in silting of bile,and make bile leak into damaged wall of gallbladder,which possibly sacrifices to XGC.Calculus incarcerated in neck of gallbladder,probably plays an important role in onset of XGC.