黄色肉芽肿性胆囊炎与胆囊癌的术前鉴别

Preoperative differential diagnosis of xanthogranulomatous cholecystitis and gallbladder carcinoma

背景由于黄色肉芽肿性胆囊炎(xanthogranulomatous chole-cystitis,XGC)和胆囊癌(gallbladder carcinoma,GBC)临床及影像学特征过于相似,故在临床诊疗过程中两者常常难以区别.本研究基于腹部超声及增强CT,分析两者人口学特征、实验室指标、肿瘤标志物以及影像学特征的差异.进而构建诊断模型,辅助临床医生诊疗.目的回顾性分析黄色肉芽肿性胆囊炎和胆囊癌病人临床及影像学特征的差异,归纳鉴别二者的危险因素并构建诊断模型.方法回顾性分析浙江省人民医院2011-01/2022-09本院术前行腹部超声联合腹部增强CT且术后病理诊断明确的67例XGC患者和139例GBC患者,分析2组患者的临床表现、实验室和影像学表检查的差异.结果分析两组患者临床及影像学特征,性别、γ-谷氨酰胺转移酶(γ-glutamyl transpeptadase,GGT)、癌胚抗原(carcinoembryonic antigen,CEA)、平均胆囊壁厚度、胆囊壁增厚方式(胆囊壁受累<50%)、是否合并胆囊结石和腹膜后淋巴结肿大是鉴别XGC与GBC的独立危险因素.GGT和CEA的最佳临界值分别为28 U/L、CEA3.2 ug/L.结论XGC与GBC的部分临床及影像学特征存在显著差异,可以为术前鉴别诊断提供参考价值.

BACKGROUND Because the clinical and imaging features of xanthogranu-lomatous cholecystitis(XGC)and gallbladder carcinoma(GBC)are very similar,it is often difficult to distinguish them clinically.Based on abdominal ultrasound and contrast-enhanced CT,this study analyzed the differences in demographic characteristics,laboratory indicators,tumor markers,and imaging features between patients with XGC and those with GBC.Then a diagnostic model was constructed to assist clinicians in the diagnosis and treatment of the two conditions.AIM To analyze the differences in clinical and imaging features between XGC and GBC patients,and to establish a diagnostic model for the two conditions.METHODS From January 2011 to September 2022,67 patients with XGC and 139 patients with GBC who underwent abdominal ultrasonography and abdominal contrast-enhanced CT and had definite postoperative pathological diagnosis at Zhejiang Provincial People’s Hospital were retrospectively analyzed.The differences in clinical manifestations and laboratory and imaging findings between the two groups were analyzed.RESULTS Gender,γ-glutamyl transpeptadase(GGT),carcinoembryonic antigen(CEA),mean gallbladder wall thickness,gallbladder wall thickening pattern(gallbladder wall involvement<50%),gallstones,and retroperitoneal lymphadenopathy were independent risk factors for differentiating XGC from GBC.The cut-off values for GGT and CEA were 28 U/L and 3.2 ug/L,respectively.CONCLUSION There are significant differences in some clinical and imaging features between XGC and GBC,which can provide reference value for their preoperative differential diagnosis.