【摘要】 目的 探讨黄色肉芽肿性胆囊炎的诊断与治疗，提高对该疾病的认识及诊治水平。 方法 对2004年9月-2009年10月确诊为黄色肉芽肿性胆囊炎的15例患者资料进行回顾性分析。 结果 确诊为黄色肉芽肿性胆囊炎3例，慢性胆囊炎8例，胆囊癌4例。10例行胆囊切除术，2例行胆囊切除加胆总管探查T管引流术，1例行胆囊大部切除加十二指肠瘘修补术，1例行胆囊大部切除加胃瘘修补术，1例行胆囊切除加胆囊床部肝组织切除。术后并发胆瘘1例，切口感染2例。无死亡病例。 结论 黄色肉芽肿性胆囊炎术前难诊断，术中冷冻切片检查和术后病理检查是诊断的关键，手术切除胆囊是主要治疗方法。【Abstract】 Objective To evaluate the clinical diagnosis and treatment of xanthogranulomatous cholecystitis. Methods The clinical data of 15 patients with xanthogranulomatous cholecystitis treated in our hospital from September 2004 to October 2009 were retrospectively analyzed. Results All of 15 patients were diagnosed as xanthogranulomatous cholecystitis through postoperative pathologic examination, including 3 were diagnosed as xanthogranulomatous cholecystitis, 8 were diagnosed as chronic cholecystitis, and 4 were diagnosed as gallbladder carcinoma. All patients underwent the operations including cholecystectomy in 10, cholecystectomy plus choledochojejunostomy and T tube drainage in 2, gallbladder subtotal plus duodenal fistula in 1, gallbladder subtotal resection of gastric fistula in 1, and cholecystectomy plus the department of the gallbladder bed resection of liver tissue in 1. The postoperative complications included biliary fistula in 1 case and wound infection in 2 cases;no deaths were found. Conclusion Xanthogranulomatous cholecystitis is difficult to diagnose before the operations. The keys of the diagnosis are the intraoperative frozen section examination and postoperative pathologic examination. Cholecystectomy is the main operation for xanthogranulomatous cholecystitis.
目的 分析黄色肉芽肿性胆囊炎（XGC）误诊为胆囊癌的原因，探讨XGC的诊断和治疗策略。方法 回顾性分析2012年我科收治的2例XGC误诊为胆囊癌患者的临床病理资料。结果 2例患者术前及术中均误诊为胆囊癌，均行胆囊切除＋肝脏Ⅳ、Ⅴ段切除＋胆道镜下胆总管探查术，其中1例还行肝门周围淋巴结清扫。术后病理回报均为XGC。2例患者术后均恢复良好，无手术并发症发生；均随访3个月，生活质量好。结论 临床上根据XGC的症状和影像学表现极易误诊为胆囊癌，建议术中冰冻病理明确诊断后选择合适的术式，防止盲目扩大手术范围，减少机体损伤和术后并发症的发生。
ObjectiveTo explore the etiological agent, clinical manifestations, imaging findings, pathologic characteristics, diagnosis, treatment, and prognosis of xanthogranulomatous cholecystitis(XGC). MethodThe clinical data of 48 patients with XGC diagnosed by postoperative pathology from January 2003 to December 2012 were collected and analyzed. ResultsIn these 48 patients with XGC, the clinical manifestations included 40(83.3%)patients with upper right abdominal pain, 18(37.5%)patients with jaundice, 12(25.0%)patients with fever. B ultrasound examination was performed in 45 cases, in which 42 cases were diagnosed with cholecystitis, 38 cases together with cholecystolithiasis, 15 cases together with cholecystolithiasis and gallbladder neoplasm, and 3 cases together with choledocholith with bile duct dilatation. CT was performed in 30 cases, in which 25 cases were diagnosed with cholecystitis together with cholecystolithiasis, 11 cases were diagnosed with gallbladder neoplasm. MRI was performed in 22 cases, in which 18 cases were diagnosed with cholecystitis together with cholecystolithiasis, 4 cases were diagnosed with gallbladder carcinoma. Thirty-three cases were treated with open cholecystectomy, 9 patients with laparoscopic cholecystectomy, 4 patients with cholecystectomy plus choledocholithotomy and T-tube drainage, 2 patients with cholecystectomy plus partial hepatectomy. All the patients were diagnosed with XGC by postoperative pathology and recovered well without recurrence and canceration. ConclusionsXGC is a kind of benign and invasive disease without specific clinical manifestation. Bultrasound, CT, or MRI play an important role in diagnosis, but final diagnosis is mainly based on pathological detection, and surgery is the most effective treatment. The prognosis of XGC is favorable if gallbladder is completely resected.
ObjectiveTo investigate clinical value of MRI examination in diagnosis of xanthogranulomatous cholecystitis (XGC), and to analyze pathologic correlation of various imaging findings. MethodsMRI imaging data of 7 patients with XGC proved by surgery and pathology who underwent entire MRI sequences examination in Sichuan Provincial People's Hospital from Jan. 2013 to Dec. 2015, were analyzed retrospectively. The thickness and contrast enhancement of gallbladder wall, gallbladder wall nodules, completeness of gallbladder mucosa lines, gallbladder stones, and the changes around the gallbladder were focused in every patient. ResultsIn 7 patients with XGC: gallbladder wall thickening occurred in all patients, in which 2 patients were local thickening, 5 patients were diffuse thickening; ‘hypodense band sign' was found by enhance scan in 4 patients; the multiple intramural nodules were presented in 5 patients, which were low signal intensity on T1WI image and high signal intensity on T2WI image; the mucosal lines were continuous in 6 patients and discontinuous in 1 patient; 6 patients combined with cholecystolithiasis. The fat layer around the gallbladder was found fuzz in 7 patients, liver and gallbladder boundaries were not clear in 7 patients; temporal enhancement of arterial phase in liver parenchyma was observed in all patients, and 1 patient combined with liver abscess. Hilar bile duct narrowed and intra-hepatic bile duct dilated in 2 patients, intra-hepatic and extra-hepatic bile duct slightly dilated in 2 patients (lower part of the choledochus stone was found in 1 patient), liver cyst was observed in 3 patients, single or double kidney cyst was observed in 4 patients; all patients were not found intraperitoneal or retroperitoneal swelling lymph nodes. ConclusionMRI examination can accurately describe various imaging features of XGC, so MRI has important value in diagnosis of XGC.
ObjectiveTo investigate clinical value of magnetic resonance imaging (MRI) in differentiating xanthogranulomatous cholecystitis (XGC) with gallbladder cancer (GBC). MethodsMRI data of 7 patients with XGC and 13 patients with GBC proved by surgery and pathology were analyzed retrospectively. The main contents of the observation included:①Maximum thickness of gallbladder wall; ②Diffuse thickening or localized thickening of gallbladder wall; ③Enhancement pattern (uniform or nonuniform) of gallbladder wall; ④Gallbladder wall sandwiches enhancement; ⑤Gallbladder wall nodules; ⑥Completeness of gallbladder mucosa lines; ⑦Obstruction of biliary tract; ⑧Calculus in gallbladder or bile duct; ⑨Involvement of adjacent liver; ⑩Definition of surrounding fat layer; Lymphadenopathy. ResultsIn above 11 MRI comparing features, these features such as the gallbladder wall sandwiches enhancement, the gallbladder wall nodules, the completeness of gallbladder mucosa lines, the biliary obstruction, and the lymphadenopathy were statistically significant between the XGC and the GBC (P < 0.05), while the rest features such as the maximum thickness of gallbladder wall, the type of gallbladder wall thickening, the gallbladder wall enhancement pattern, the calculus in gallbladder or bile duct, the involvement of adjacent liver, and the definition of surrounding fat layer were not statistically significant between the XGC and the GBC (P > 0.05). ConclusionMRI has important values in differentiating XGC with GBC.