黄色肉芽肿性胆囊炎的诊治(附22例报告)

目的　探讨黄色肉芽肿性胆囊炎 (XGC)的诊断和治疗。方法　对我院 1 990年 2月 -2 0 0 0年 3月间收治的 2 2例XGC作回顾性分析。结果　XGC占同期胆囊标本的 1 .4% (2 2 1 5 2 3 )。临床表现与一般胆囊炎类似 ,B超示胆囊壁不规则隆起或增厚 7例 ,CT检查 5例怀疑为胆囊癌 ,肿瘤标志物检查 1例铁蛋白 (SF)轻度升高 ;伴黄疸 4例中 1例合并胆总管结石 ,1例合并胰头癌。术前全部误诊。术中冰冻切片检查 1 0例 ,4例确诊为XGC ,其余为术后病理诊断。行胆囊大部切除术 2例 ,胆囊切除加肝边缘不规则切除术 2例 ,其余行单纯胆囊切除。全部治愈。结论　XGC是一种特殊类型的胆囊炎 ,临床表现不典型 ,易与胆囊癌相混淆 ,术前难于诊断。组织病理学检查是确诊的重要手段。胆囊切除是常用的术式 ,不能排除胆囊癌时应扩大手术范围。本病预后良好

Diagnosis and treatment of xanthogranulomatous cholecystitis: report of 22 cases

Objective Exploring the diagnosis and treatment of xanthogranulomatous cholecystitis(XGC). Methods Clinical data of 22 patients with XGC admited in our hospital from February 1990 to May 2000 were analyzed retrospectively. Results 22 cases of XGC were found in 1 523 cholecystectomies(1.4%). The clinical features were similar to commonly cholecystitis. The B scan ultrasound indicated thickened or protuberant gallbladder wall in 7 patients, 5 cases were suspected of gallbladder carcinoma by CT. Tumor indicator examination showed scan ferritin were raised mildly in one case. One common bile duct stone and one carcinoma of head of pancreas were found in 4 cases with jaundice. None of these patients were correctly diagnosed preoperatively. Frozen section examination were made in 10 patients during operation and XGC indicated in 4 cases. The others were diagnosed by pathological examination postoperatively. Subtotal cholecystectomy were performed in 2 cases, cholecystectomy plus hepatic-wedged resection in 2 cases, and cholecystectomy in 18 cases. All patients were cured. Conclusions XGC is a special inflammatory disease of gallbladder without typical clinical presentation, it is difficult to diagnose preoperatively and confused with gallbladder carcinoma in most cases. Histopathology of the gallbladder is important for diagnosis. Cholecystectomy is the general procedure and extended resection is required if gallbladder carcinoma can't be ruled out. Good results could be anticipated in almost all patients.