黄色肉芽肿性胆囊炎与胆囊癌的鉴别诊断

目的探讨黄色肉芽肿性胆囊炎（XGC）和胆囊癌的临床特点及鉴别要点，以减少黄色肉芽肿性胆囊炎的误诊率。方法收集经病理确诊为黄色肉芽肿性胆囊炎（23例）和胆囊癌（51例）患者的临床资料并进行统计分析。结果23例黄色肉芽肿性胆囊炎临床表现类似一般的胆囊炎，术前B超32％（7／22）胆囊癌不能排除，术前MRI或CT检查52％（12／23）误诊为胆囊癌，4％（1／23）误诊为胆囊腺肌症。术中冷冻病理检查7例XGC均排除胆囊癌，术后病RI胆囊癌诊断正确性为7例，检查23例黄色肉芽肿性胆囊炎均确诊。51例胆囊癌临床表现无特异性，术前B超胆囊癌诊断正确性为73％（33／45），术前CT及MRI诊断正确性为78％（35／44），术后病理检查51例胆囊癌均得以确诊。结论黄色肉芽肿性胆囊炎无特异性症状和体征，影像学检查的特征性表现不明显，极易误诊为胆囊癌。术中冰冻切片检查可明确病变性质，指导手术方式的选择。确诊黄色肉芽肿性胆囊炎需依赖病理检查。

The differential diagnosis between xanthogranulomatous cholecystitis and gallbladder cancer

Objective By investigating the xanthogranulomatous eholecystitis （xanthogranulomatous cholecystitis, XGC） and gallbladder cancer in the clinical features and differential diagnosis and to reduce the misdiagnosis rate of XGC. Methods Collect the clinical datas of patients with pathological diagnosis of XGC （23 cases）and gallbladder cancer（ 51 cases） for statistical analysis. Results Clinical manisfestations of 23 cases of XGC were similar to the general cholecystitis ,32% （7/22） gallbladder cancers can not be excluded by preoperative B -ultrasound scanning,by preoperative CT or MRI examinations,52% （12/23）were misdiagnosed as gallbladder cancer,and 4% （1/23）were misdiagnosed as adenomyomatosis of gallbladder. Pathological examinations of intraoperative frozen 7 cases of XGC were excluded gallbladder cancer, and postoperative pathological examinations of 23 cases of XGC were confirmed. Clinical manisfestations of 51 cases of gallbladder cancer were of non - specific, and the correct diagnosis rate of gallbladder cancer was 73 % （ 33/45 ） by preoperative B - ultrasound scanning, the correct diagnosis rate of gallbladder cancer was 78% （35/44）by preoperative CT and MRI. Postoperative pathological examinations of 51 cases of Gallbladder cancer were all confirmed. Conclusion Clinical manisfestations of XGC are of non - specific symptoms and signs, and radiological examination of the characteristic features are not obvious, which lead to be easily misdiagnosed as gallbladder cancer. Intraoperative frozen section examination can crystallize pathological nature, in order to guide surgical option. Diagnosis of XGC is dependent on pathological examination.