黄色肉芽肿性胆囊炎的诊断及鉴别诊断

目的 探讨黄色肉芽肿性胆囊炎（XGC）的临床表现、实验室检查情况、影像学检查表现特点,旨在提高XGC的术前诊断率.方法 回顾性分析12例经手术病理证实XGC患者的临床表现、实验室指标及病变的超声、CT及MRI表现特点,例如,胆囊壁内结节、黏膜线、胆囊壁增厚情况及强化方式、是否合并结石、胆囊周围脂肪及肝实质是否受累以及胆道梗阻情况.结果 12例患者均出现右上腹痛,11例白细胞及粒细胞不同程度升高;7例CA 199轻度升高但低于正常值5倍,CEA轻度升高1例;超声、CT、MRI表现为胆囊壁增厚,其中弥漫性增厚9例,8例见多发壁内结节,部分结节超声表现为低回声（带）、CT为低密度、MRI呈较长T1长T2.CT及MRI增强结节未见明显强化,6例增强CT、MRI粘膜线完整强化,11例病例合并胆囊结石,仅1例出现胆道梗阻,1例邻近肝实质受累.结论 综合分析患者临床表现、实验室指标及影像学检查结果,能明显提高XGC诊断准确率,为手术方案选择提供有力依据.

The diagnosis and differential diagnosis of Xanthogranulomatous cholecystitis

Objective To investigate clinical manifestation, laboratory examination and imaging features of xanthogranu lomatous cholecystitis （XGC）, aimed to improve the preoperative diagnostic rate of XGC. Methods A retrospective analy- sis was performed on 12 patients with histological confirmed XGC, including clinical manifestation, laboratory examina tion, ultrasonography, CT and MRI features, such as the presence of intramural nodules, mucosal line, the patterns of wall thickening and enhancement and the presence of stones in the gallbladder. Changes of adjacent fat tissue and liver pa- renchyma and biliary obstruction were also reviewed. Results All of the 12 patients showed right upper abdominal pain, white blood cells and neutrophils increased in 11 cases; CA199 in 7 cases slightly increased but lower than 5 times of the normal value, CEA was mildly increased in 1 case; Ultrasound, CT, MRI showed gallbladder wail thickening, in which 9 cases presented with diffused thickening; multiple intramural nodule can be seen in 8 cases, which showed low echo on ul trasound, low density on CT and low signal on T1 WI and high signal on T2 WI and no enhancement was observed; 6 cases had intact mucosal lining on MRI; 11 cases prensented with cholecystolithiasis. Biliary obstruction and involvement of ad- jacent liver parenchyma can be seen in one case, respectively. Conclusion Comprehensive analysis of clinical manifesta- tions, laboratory examination and imaging examination results of patients can obviously increase the diagnostic accuracy of XGC and provide powerful basis for surgical options.