59例黄色肉芽肿性胆囊炎诊治的回顾性分析

Retrospective analysis of diagnosis and treatment for xanthogranulomatous cholecystitis in 59 cases

目的探讨黄色肉芽肿性胆囊炎(XGC)的临床诊断与治疗。方法回顾性分析病理确诊为黄色肉芽肿性胆囊炎的59例临床资料。结果术中中-重度以上黏连18例,胆囊积液、积脓20例,穿孔2例,术前或术后加做逆行胰胆管造影(ERCP)或内镜下十二指肠乳头括约肌切开取石术(EST)或内镜鼻胆管引流术(ENBD)17例,扩大手术5例,1例因伴慢性胰腺炎行胆囊和胃窦切除加胰头囊肿十二指肠引流术,38例行LC术,4例中转开腹。临床治愈59例,无手术死亡病例。结论XGC是一种少见的特殊类型的慢性胆囊炎,术前诊断困难,确诊依赖病理检查。术式以胆囊切除为主,不应盲目地扩大手术,仍应考虑LC术的实施。

Objective To approach the diagnosis and treatments of xanthogranulomatous cholecystitis（XGC）. Methods The clinical data of 59 patients was retrospectively analysed. Results 18 cases were moderate to severe adherence,20 cases were fluidi- fled or empyema,and 2 cases were perforation. In addition to cholecystectomy, 17 cases were executed with ERCP or EST or EN- BD,Scases were enlarged,lcase was executed with sinus ventriculi exsection and pancreatic cyst duodenal drainage, 38 cases were executed with laparoscopic cholecystectomy,but 4 cases were failed. All patients were clinical cured. Conclusion XGC is a rare and special type of chronic cholecystitis. It is difficult to diagnose before operation. Final dignosis depends on pathological examinations. The cholecystectomy is mainly operation,laparoscopic cholecystectomy is preferred.