黄色肉芽肿性胆囊炎的影像学研究及治疗进展

Advances in imaging research and treatment of xanthogranulomatous cholecystitis

黄色肉芽肿性胆囊炎(XGC)是一种十分少见且较为特殊的具有破坏性的变异性胆囊慢性炎性疾病,对于其发病机理尚不能明确,临床症状与慢性胆囊炎相似。影像技术的多元化、新技术的不断发展、影像诊断水平的不断提高为术前正确诊断做出了贡献。超声CT及核磁共振(MRI)是最常用的影像检查方法,超声的动态性及可重复性是其观察胆囊的主要优势,多层螺旋CT(MSCT)的应用也越来越来普遍,尤其是高分辨率CT(HRCT)、多平面重建(MPR)及三维重建等后处理技术使胆囊可以多方位被观察,能谱CT可以提供病变更多的信息,MRI的多参数成像,尤其是磁共振胰胆管造影(MRCP)是诊断胆囊疾病的重要检查方法,且多种影像方法的结合是现在诊断的趋势。但仍有部分病例不能准确与胆囊癌相鉴别,术前做出确定性诊断存在一定的难度,最终确诊依赖病理检查,大体病理特征是胆囊壁增厚,重度增生纤维化,黄色肉芽肿结节分布其中。XGC具有潜在恶变可能,因此对于可疑或确诊XGC应积极行手术治疗。

Xanthogranulomatous cholecystitis(XGC)is a very rare and special chronic inflammatory disease of gallbladder with destructive variability.The pathogenesis of XGC is not clear,and its clinical symptoms are similar to chronic cholecystitis.The diversification of image technology,the continuous development of new technology and the continuous improvement of image diagnosis level contribute to the correct preoperative diagnosis.Ultrasound CT and magnetic resonance(MRI)are the most commonly used imaging methods.The dynamic and repeatability of ultrasound is the main advantage of observing the gallbladder.The application of multi-slice spiral CT(MSCT)is more and more common,especially the post-processing technology such as HRCT,MPR and 3 D reconstruction,which enables the gallbladder to be observed in multiple directions.Energy spectrum CT can provide more information of lesions.Multi parameter MRI imaging,especially magnetic resonance cholangiopancreatography(MRCP)is an important method for the diagnosis of gallbladder diseases,and the combination of multiple imaging methods is the current trend of diagnosis.However,there are still some cases that can not be accurately differentiated from gallbladder cancer.It is difficult to make a definite diagnosis before operation.The final diagnosis depends on pathological examination.The general pathological features are thickening of the gallbladder wall,severe hyperplasia and fibrosis,and the distribution of yellow granuloma nodules.XGC has the potential of malignant transformation,so it should receive operation actively for suspected or confirmed XGC.