黄色肉芽肿性胆囊炎与胆囊癌的鉴别诊断及术中决策

Differential diagnosis and management strategies of xanthogranulomatous cholecystitis and gallbladder carcinoma

黄色肉芽肿性胆囊炎是一种少见类型的胆囊炎,发病机制尚未完全清楚。因其胆囊壁弥漫性不均匀增厚及向周围器官浸润等特点而与胆囊癌难以鉴别,其病史体征、肿瘤标记物及影像学特点均不典型,加之部分病例合并有胆囊癌,术前难以做出确定性诊断。术前和术中细针穿刺冰冻病理学检查的诊断率相对较高,对手术方式选择有重要参考意义。因腹腔镜胆囊切除术的术中中转开腹率及并发症发生率很高,故临床多选择开腹胆囊切除术,依术中所见及冰冻病理学检查结果选择恰当的术式。

Xanthogranulomatous cholecystitis （XGC） is a rare type of cholecystitis, and the etiopathogenesis of XGC is not fully understood. It is difficult to differentiate XGC from gallbladder carcinoma by symptoms, physical examination, laboratory tests, and radiographic findings because of uneven thickening gallbladder wall and severe adhesions with surrounding organs, especially in some cases associated with gallbladder carcinoma. Preoperative and intraoperative diagnosis rate is poor. Preoperative and intraoperative fine needle aspiration cytology and frozen pathology is important to the intraoperative surgical management. Because of a high conversion rate （laparoscopic to open cholecystectomy） and incidence of complications with laparoscopic cholecystectomy, open surgery is suggested. The appropriate surgical procedures should be performed according to intraoperative frozen pathology results.