黄色肉芽肿性胆囊炎临床诊治策略研究(附110例回顾性分析)  

Clinical diagnosis and treatment strategies for xanthogranulomatous cholecystitis:a retrospective analysis of 110 cases

作　　者：段克才 董志涛 方鲲鹏 隋承军 戴炳华 耿利 杨甲梅 DUAN Ke-cai;DONG Zhi-tao;FANG Kun-peng(Department of Special Needs Clinic,Third Affiliated Hospital of Naval Medical University(Shanghai Eastern Hepatobiliary Surgery Hospital),Shanghai,200438,China)

机构地区：[1]海军军医大学第三附属医院(上海东方肝胆外科医院)特需诊疗科,上海200438

出　　处：《中国实用外科杂志》2024年第12期1407-1411,共5页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金面上项目(No.82173145);教育部产学合作协同育人项目(No.230825162507275);上海市自然科学基金项目(No.21ZR1478400);上海市卫生健康委员会基金项目(No.202240313)。

摘　　要：目的 探讨黄色肉芽肿性胆囊炎(XGC)的临床特点,提高术前诊断的准确性,优化诊疗策略。方法回顾性分析2018年1月至2022年12月海军军医大学第三附属医院(上海东方肝胆外科医院)收治的110例XGC病人与同期110例胆囊癌(GBC)病人的临床资料,包括一般情况、临床表现、影像学检查结果、术前诊断及治疗过程。对两组病人的特点进行比较分析,结合术中和术后病理诊断结果进行总结。结果 XGC组平均年龄为(60.7±10.0)岁,男女发病率比为2.4∶1。XGC术前诊断正确率为8.2%(9/110),40.0%(44/110)误诊为GBC。XGC病人术中冰冻切片病理检查诊断阳性率为85.5%(71/83),术后病理确诊率达100%。影像学特征包括胆囊壁内结节、囊壁弥漫增厚、黏膜线完整及增强后呈“夹心饼干征”。与GBC组相比,XGC组在CA19-9是否升高差异无统计学意义(P=0.281),但CEA升高情况差异有统计学意义(P<0.001)。手术治疗中,43例行胆囊切除术,其中腹腔镜胆囊切除术中转开放手术率为41.2%。开放胆囊切除术未显著增加手术时间(P>0.05),但住院时间较腹腔镜手术延长(P<0.05)。术后并发症发生率为14.5%(16/110),包括腹腔出血、胆漏及切口感染。结论 XGC是一种良性疾病,术前极易误诊为GBC,导致手术范围不当扩大。XGC的特征性影像学表现对于术前诊断具有重要意义;建议针对拟诊XGC病人慎重选择腹腔镜手术,常规术中冰冻病理检查以排除恶性病变。术后诊断明确的XGC病人预后良好,但需警惕并发症的发生并采取针对性措施以降低术后风险。Objective To explore the clinical characteristics of xanthogranulomatous cholecystitis(XGC),improve the accuracy of preoperative diagnosis,and optimize diagnostic and therapeutic strategies.Methods A retrospective analysis was conducted on the clinical data of 110 XGC patients and 110 gallbladder cancer(GBC) patients admitted at Third Affiliated Hospital of Naval Medical University(Shanghai Eastern Hepatobiliary Surgery Hospital) between January 2018 and December 2022.Data collected included general information,clinical presentations,imaging findings,preoperative diagnoses,and treatment processes.The characteristics of the two groups were compared,and intraoperative and postoperative pathological results were summarized.Results The mean age in the XGC group was(60.7±10.0)years old,with a male-to-female ratio of 2.4∶1.The accuracy of preoperative diagnosis for XGC was 8.2%(9/110),while40.0%(44/110) of cases were misdiagnosed as GBC.The positive diagnostic rate of intraoperative frozen section pathology was 85.5%(71/83),and the postoperative pathological confirmation rate reached 100%.Imaging characteristics included nodules within the gallbladder wall,diffuse thickening of the gallbladder wall,an intact mucosal line,and the “layered sandwich sign” oncontrast-enhanced scans.Compared with theGBC group,the XGC groups showed nostatistically significant difference in elevatedCA19-9 levels(P=0.281) but a statisticallysignificant difference in elevated CEA levels(P<0.001).In surgical treatment,43 patients underwent cholecystectomy,with a conversion rate from laparoscopic to open surgery of 41.2%.Open cholecystectomydid not significantly increase operative time(P>0.05),but it was associated with a longer hospital stay compared tolaparoscopic surgery(P<0.05).The postoperative complication rate was 14.5%(16/110),including abdominal bleeding,bile leakage,and wound infections.Conclusion XGC is a benign disease that often is preoperatively misdiagnosed asGBC,leading to unnecessary surgical extensions.The characteristic

关 键 词：黄色肉芽肿性胆囊炎 胆囊癌 胆囊内瘘 胆囊切除术 

分 类 号：R6[医药卫生—外科学]