黄色肉芽肿性胆囊炎误诊为胆囊癌十例分析

Xanthogranulomatous cholecystitis misdiagnosed as gallbladder carcinoma: a report of 10 cases

目的分析黄色肉芽肿性胆囊炎(xanthogranulomatous cholecystitis,XGC)误诊为胆囊癌的原因。方法分析我院1996-2005年间确诊为黄色肉芽肿性胆囊炎的33例的临床资料,其中10例在术前和术中误诊为胆囊癌。结果10例患者中B超和CT均诊断为胆囊癌5例,慢性胆囊炎1例;B超诊断为胆囊癌而CT诊断为慢性胆囊炎2例;B超诊断为慢性胆囊炎而CT诊断为胆囊癌2例;术中均见有胆囊壁增厚,胆囊与肝、大网膜等周围组织粘连。3例行胆囊切除+肝部分切除术, 6例行胆囊切除+肝部分切除术+肝十二指肠韧带清扫术,1例行部分胆囊切除+胆囊空肠吻合+横结肠部分切除。术后病理为黄色肉芽肿性胆囊炎。结论黄色肉芽肿性胆囊炎影像学表现和肉眼所见易误诊为胆囊癌。确诊需依赖病理检查。术中冰冻组织学检查有助于明确病变性质。

Objective The aim of this study was to analyze the causes of misdiagnosing xanthogranulomatous cholecystitis （XGC） as carcinoma of gallbladder. Methods Clinical data of 33 XGC patients admitted from 1996 to 2005 were retrospectively analyzed, among them 10 patients were misdiagnosed as carcinoma of the gallbladder preoperatively and intraoperatively. Results All these 10 patients underwent preoperative ultrasound and computed tomography （CT）. Both ultrasound and CT were suggestive of carcinoma of the gallbladder in 5 cases, and chronic cholecystitis in one case. The ultrasound was suggestive of carcinoma while CT diagnosed as chronic cholecystitis in 2 cases. CT suggested a carcinoma while ultrasound was suggestive of cholecystitis in other 2 cases. Thickened gallbladder wall and dense carcinoma-like adhesions was unanimous phenomena. Cholecystectomy and partial hepatic wedge resection was performed in 3 cases; Six cases underwent cholecystectomy and partial hepatic wedge resection plus regional lymphadenectomy. One case received partial cholecystectomy, cholecystoenterostomy, and partial transverse colectomy. XGC was definitely diagnosed by postoperative pathological examination in all of patients. Conclusions XGC mimics the imaging features （CT, uhrasonography ） and gross findings of gallbladder carcinoma making a misdiagnosis. Definite diagnosis of XGC is dependent on postoperative pathology.