黄色肉芽肿性胆囊炎的治疗

Surgical Treatment of Xanthogranulomatous Cholecystitis

目的探讨黄色肉芽肿性胆囊炎(xanthogranulomatous cholecystitis,XGC)的治疗.方法回顾分析总结1995年9月～2003年9月经病理诊断的24例XGC的经验.结果占同期850例胆囊切除术的2.8%.全部病例均行B超及CT检查.术前拟诊7例,诊断为胆囊癌8例.所有胆囊与周围组织有不同程度的浸润粘连.20例经术中冰冻切片病理检查确诊,4例未确诊.手术方式:单纯胆囊切除12例,附加胆总管探查、T管引流5例及胃大部切除2例,4例行肝楔性切除+肝十二指肠韧带骨骼化清扫,1例行胆囊大部切除+肝段切除.结论 XGC是一种特殊类型的胆囊炎,术前难以明确诊断.影像学检查易与胆囊癌混淆,确诊依赖病理检查,手术切除胆囊是早期诊断及治疗的最佳途径.

Objective To probe into the treatment of xanthogranulomatous cholecystitis (XGC). Methods To review the clinical data of 24 patients with XGC diagnosised definitely on pathological examination between Sept 1995~Sept 2003. Results 2.8% with XGC were found in 850 cholecystectomies(2.5%) performed in our hospital.All patients were examined with B-ultra sound and CT. Preoperation diagnosis was XGC in 7 cases and gallbladdler carcinoma in 8 cases. In all patients xanthogranulomatous tissue invaded into other tissue in operation. 20 cases were diagnosised definitely on intra freezing pathological examination,4 cases uncertain. Complete Cholecystectomy was executed in 12 cases,In addition to Cholecystectomy,5 cases were executed exploratory choledochostomy and T tube drainage,2 cases with greater partial gastrectomy,4 cases with partial liver wedge resection beneath gallbladder bed and lymph node clearing in liver duodenum ligament,1 case with greater partial cholecystectomy and hepatic segment resection. Conclusion XGC is a rare and special type chronic cholecystitis,which is difficult to diagnose preoperatively.It is liable to be confused with cholecyst carcinoma in reflection photograph test.Definte diagnosis depends on pathological examination.The optimal means of early diagnosis and treatment is cholecystectomy.