胆囊腺肌增生症459例报告  

Adenomyomatosis of Gallbladder: Report of 459 Cases

作　　者：何潇 徐智[2] 崔龙[2] 王港[2] He Xiao;Xu Zhi;Cui Long(Department of General Surgery,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]常州市第二人民医院乳腺外科,常州213003 [2]北京大学第三医院普通外科,北京100191

出　　处：《中国微创外科杂志》2018年第11期961-963,968,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：北京大学第三医院重点项目(BYSY201207)

摘　　要：目的探讨胆囊腺肌增生症(adenomyomatosis of gallbladder,ADM)的流行病学特征、临床表现、诊断及治疗方法,为临床诊断和治疗ADM提供指导。方法检索我院2000年1月1日～2015年12月31日病理数据库14 299例胆囊切除术的临床资料,选取经病理证实为ADM 459例,对其流行病学特征、临床表现、各种影像学检查的诊断率、手术方式、病理等进行回顾性分析。结果 419例(91. 3%)行腹腔镜胆囊切除术,40例(8. 7%)腹腔镜中转开腹或开腹胆囊切除术。ADM在胆囊切除标本中发现率为3. 2%。427例(93. 0%)合并胆囊炎,284例(61. 9%)合并胆囊结石,54例(11. 8%)合并胆固醇性息肉或胆固醇沉积症,12例(2. 6%)合并胆囊腺瘤,2例(0. 4%)合并胆囊癌。超声、增强CT、MRCP或增强MRI术前诊断率分别为24. 5%(96/392),40. 7%(55/135),39. 6%(108/273)。结论 ADM多发于50～59岁人群,常合并胆囊炎和胆囊结石。术前超声联合增强CT、MRCP或增强MRI的诊断率较单纯超声检查高。腹腔镜胆囊切除术仍然是治疗ADM的主要治疗方式。Objective To study the epidemiological features, clinical features, diagnosis and treatment of adenomyomatosis of gallbladder and explore the individualized and appropriate treatment strategy. Methods From January 1, 2000 to December 31, 2015, a total of 14 299 patients underwent cholecystectomy in our hospital. Among them, 459 patients pathologically diagnosed as having adenomyomatosis of the gallbladder were selected for this study. The epidemiological features, diagnostic rate of different imaging examinations, surgical treatment, and pathological findings were retrospectively analyzed. Results Laparoscopic cholecystectomy（LC） was performed in 419（91.3% ） patients,and LC converted to open cholecystectomy （OC） or OC was performed in 40 patients （ 8. 7% ）. Adenomyomatosis of gallbladder was found in 3. 2% of cholecystectomy specimens. A total of 427 cases （93.0%） were accompanied with cholecystitis, 284 cases （61.9%） were accompanied with gallbladder stones, 54 cases （ 11.8% ） were accompanied with cholesterol polyp or deposition, 12 cases （2.6%）were accompanied with gallbladder adenoma, and 2 cases （0. 4% ） were accompanied with carcinoma of gallbladder. The diagnostic rate of ultrasonography, contrast-enhanced computed tomography, MRCP or contrast-enhanced MRI was 24.5% （96/392） , 40.7% （55/135） , 39. 6% （108/273） , respectively. Conclusions Adenomyomatosis of the gallbladder is mainly found in people aged 50 - 59 years old. It is always accompanied with cholecystitis and gallbladder stones. Ultrasonography combined with contrast-enhanced CT, MRCP or contrast-enhanced MRI has a higher diagnostic rate than ultrasonography alone. Currently LC is the main procedure for the treatment of adenomyomatosis of the gallbladder.

关 键 词：胆囊腺肌增生症 流行病学特征 胆囊切除术 

分 类 号：R657.4[医药卫生—外科学]