黄色肉芽肿性胆囊炎78例临床分析  

Xanthogranulomatous cholecystitis： a clinical analysis of 78 cases

作　　者：杨维良[1] 李胜龙[1] 韩丽姝[2] 张浩民[3] 王夫景[1] 

机构地区：[1]哈尔滨医科大学附属第二医院普外科,150086 [2]哈尔滨医科大学附属第二医院病理科,150086 [3]齐齐哈尔医学院附属第二医院普外科

出　　处：《中华普通外科杂志》2013年第11期854-856,共3页Chinese Journal of General Surgery

摘　　要：目的探讨黄色肉芽肿性胆囊炎（xanthogranulomatouscholecystitis，XGC）的病因、诊断及治疗。方法回顾性分析1985年1月至2012年12月78例经病理确诊的XGC患者的临床资料。结果78例患者均行B超检查，其中50例同时行CT检查，术前诊断：慢性结石性胆囊炎60例，胆囊癌伴胆囊结石8例，胆囊占位性病变10例。术前诊断胆囊结石的68例中胆囊颈结石并嵌顿者达67例，占98．5％，由于胆汁淤积、渗入破损的胆囊壁，可引起XGC的发生。78例均行手术治疗：胆囊切除术48例，胆囊部分切除或大部切除术13例，胆囊切除加肝脏部分楔形切除术12例，胆囊与周围粘连成块状误诊为胆囊癌行肝脏部分切除术5例；其中合并胆总管结石17例同时行胆总管切开取石术；损伤肝总管2例同时行胆管空肠Roux—en—Y形吻合术。78例手术或易或难，可顺利完成，无严重并发症。结论XGC是一种特殊类型慢性胆囊炎，并伴黄色肉芽肿形成。术前诊断困难，术中快速冷冻或术后石蜡切片病理检查是诊断的关键手段。Objective To study the etiology, diagnosis and treatment of xanthogranulomatous cholecystitis （XGC）. Methods Clinical data of 78 cases with xanthogranulomatous cholecystitis （ confirmed by postoperative pathology） from January 1985 to December 2012 were reviewed retrospectively. Results All 78 cases underwent ultrasonography, 50 cases did CT scan. Preoperative diagnosis included chronic calculous cholecystitis in 60 cases, gallbladder carcinoma with cholelithiasis in 8 cases, gallbladder space-occupying lesions in 10 cases. Among those 68 cases of tentative gallstone disease, 67 cases were with gallbladder neck incarcerated stones. Surgery were performed in all 78 cases including cholecysteetomy in 48 cases, partial cholecystectomy or subtotal resection in 13 cases, cholecystectomy with partial hepatic wedge resection in 12 cases. Intraoperatively 5 cases were misdiagnosed as the carcinoma of the gallbladder and underwent partial liver resection along with cholecystectomy. 17 cases underwent choledocholithotomy. 2 cases suffered from hepatic duet injury and received Roux-en-Y hepatojejunal anastomosis. Conclusions XGC is a special type of chronic cholecystitis, and accompanied by yellow granuloma formation. Preoperative diagnosis of XGC is often difficult, the definite diagnosis depends on intraoperative frozen and postoperative paraffin pathology.

关 键 词：胆结石 胆囊炎 肉芽肿 

分 类 号：R657.4[医药卫生—外科学]