黄色肉芽肿性胆囊炎的诊断和外科治疗  

Diagnosis and surgical treatment of xanthogranulomatous cholecystitis

作　　者：李镇利 杨田[1] 

机构地区：[1]第二军医大学东方肝胆外科医院肝胆外科,上海200438

出　　处：《临床肝胆病杂志》2017年第2期247-252,共6页Journal of Clinical Hepatology

基　　金：国家自然科学基金(81472284;81672699);上海市浦江人才计划(16PJD004);上海市青年拔尖人才计划

摘　　要：黄色肉芽肿性胆囊炎(XGC)是一类罕见的慢性胆囊炎,其特征性病变是胆囊壁上伴有巨噬细胞和泡沫细胞浸润的严重增生性纤维化。由于XGC与胆囊癌的临床表现和影像学特征具有相似性,临床上XGC常被误诊为胆囊癌,造成了不必要的大范围手术切除,给患者带来了不良的影响。目前XGC的术前诊断多是基于影像学检查(超声、CT和MRI等),明确诊断仍然依赖于术中冰冻活组织检查或术后病理检查。同时,XGC诊断时应与胆囊腺肌瘤病、胆囊癌和胆囊放射菌病相鉴别。开腹或腹腔镜胆囊切除术是治疗XGC的最主要手段,其中,腹腔镜胆囊切除术耗时长、并发症多、中转率高。所以针对XGC,术前诊断和术中决策是外科医生面临的一大难题。Xanthogranulomatous cholecystitis （XGC） is a rare type of chronic cholecystitis characterized by severe proliferative fibrosis with infiltration of macrophages and foamy cells in the gallbladder wall. Since XGC and gallbladder carcinoma have similar clinical manifestations and radiological features, XGC is often misdiagnosed as gallbladder carcinoma in clinical practice, which leads to unnecessary extensive surgical resection and has an adverse effect on patients. At present, the preoperative diagnosis of XGC is still based on imaging results （ ultrasound, computed tomography, and magnetic resonance imaging）, and a definite diagnosis of this disease relies on intraoperative frozen biopsy or postoperative pathological examination. Meanwhile, XGC should be differentiated from gallbladder adenomyomatosis, gallbladder carcinoma, and gallbladder actinomycosis. Laparotomy or laparoscopic cholecystectomy is the major method for the treatment of XGC, but laparoscopic cholecystectomy is associated with a longer time of operation, more complications, and a higher rate of conversion to laparotomy. Therefore, surgeons are facing difficulties in preoperative diagnosis and intraoperative decision - making process of XGC.

关 键 词：胆囊炎 胆囊肿瘤 诊断 鉴别 胆囊切除术 

分 类 号：R657.41[医药卫生—外科学]