胆囊腺肌增生症的诊治分析

The diagnosis and treatment of adenomyomatosis

目的探讨胆囊腺肌增生症的临床特点及治疗方法。方法回顾性分析1992--2007年收治的33例胆囊腺肌增生症的临床资料。结果33例患者中弥漫型14例（42％），节段型10例（30％），局限型9例（27％）。合并胆囊结石21例（64％），合并胆囊炎11例（33％）。临床症状无特征性表现，以上腹疼痛、进食后不适、恶心呕吐为主。术前临床确诊4例，影像学确诊2例。28例行腹腔镜胆囊切除术，3例行开腹胆囊切除术，1例同时行胆总管探查、T管引流术，1例同时行肝血管瘤切除术。术后病理诊断均为胆囊腺肌增生症。结论胆囊腺肌增生症常合并胆囊结石、胆囊炎，临床表现不具特异性，术前确诊依赖于影像学检查。该病有潜在恶性变可能，胆囊切除术为有效的治疗方法。

Objective To investigate the clinical feature and treatment of adenomyomatosis of the gallbladder （GBA）. Methods Thirty-three cases of GBA admitted from 1992 to 2007 were reviewed retrospectively and their clinical characters were summarized. Results These cases were divided into three types grossly： 14 cases of diffuse type, 10 cases of segmental type and 9 cases of localized type. Cholelithiasis was associated in 21 cases and 11 cases with cholecystitis. Main clinical presentations included pain in the upper abdomen, discomfort after meal, nausea and vomit. Preoperative correct diagnosis was achieved in only six cases. Twenty-eight patients underwent laparoscopic cholecystectomy and three did open cholecystectomy. Concomitant exploration of common bile duct with T tube drainage and resection of liver angioma was performed in one each. Adenomyomatosis of the gallbladder was diagnosed by pathologic examination in all cases. Conclusions Due to the high rate of combination with cholelithiasis and cholecystitis, GBA has no specific clinical manifestations. The preoperative diagnosis lies on radiological examinations. Cholecystectomy is an appropriate treatment as adenomyomatosis of the gallbladder has a malignant potential.