CAJ | 학술논문

目的探讨黄色肉芽肿性胆囊炎(xanthogranulomatous cholecystitis,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.
목적 탐토황색육아종성담낭염(xanthogranulomatous cholecystitis,XGC)적병인、진단급치료.방법 회고성분석1985년1월지2012년12월78례경병리학진적XGC환자적림상자료.결과 78례환자균행B초검사,기중50례동시행CT검사,술전진단:만성결석성담낭염60례,담낭암반담낭결석8례,담낭점위성병변10례.술전진단담낭결석적68례중담낭경결석병감돈자체67례,점98.5％,유우담즙어적、삼입파손적담낭벽,가인기XGC적발생.78례균행수술치료:담낭절제술48례,담낭부분절제혹대부절제술13례,담낭절제가간장부분설형절제술12례,담낭여주위점련성괴상오진위담낭암행간장부분절제술5례;기중합병담총관결석17례동시행담총관절개취석술;손상간총관2례동시행담관공장Roux-en-Y형문합술.78례수술혹역혹난,가순리완성,무엄중병발증.결론 XGC시일충특수류형만성담낭염,병반황색육아종형성.술전진단곤난,술중쾌속냉동혹술후석사절편병리검사시진단적관건수단.
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 cholecystectomy in 48 cases,partial cholecystectomy or subtotal resection in 13 eases,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 duct 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 fiozen and postoperative paraffin pathology.