黄色肉芽肿性胆囊炎诊治分析.pdf
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1、黄色肉芽肿性胆囊炎诊治分析 何敏,王坚,陈涛,戴佳奇 上海交通大学医学院附属仁济医院普外科 200127【摘要】目的:探讨黄色肉芽肿性胆囊炎的诊治要点。方法:回顾性分析我院2000年至今收治的26例黄色肉芽肿性胆囊炎患者的临床资料。结果:随访 22 例,随访率 84.6,均存活。术前均行 B 超检查,CT 检查者 6 例,行 MRCP 检查者 4 例,行 PET-CT 检查者 1例,B 超确诊 16 例,占 61.5%,联合影像学检查确诊 18 例,占 69.2%,术前误诊为胆囊癌者 8例,占 30.8%,所有未确诊病例术中均做冰冻病理检查,最终排除胆囊癌。单纯胆囊切除术者 20 例,其中 1
2、6 例尝试腹腔镜胆囊切除术,中转开腹 10 例,占 62.5,行胆囊切除肝部分切除者 2 例,行胆囊切除胆总管整形 T 管外引流者 4 例。术后胆漏 3 例,腹腔出血 1 例,伤口感染 2例,并发症率 23.1,均治愈,无手术死亡。结论:黄色肉芽肿性胆囊炎术前诊断与胆囊癌较难鉴别,术中病理检查可降低误诊率,手术以胆囊切除术为主,可选择腹腔镜胆囊切除术,但中转开腹率明显高于一般胆囊结石手术,对于合并Mirizzi 综合症胆管狭窄者可行胆管整形术,对于扩大切除术的使用应慎重,一般仅用于术中仍无法排除胆囊癌者。【关键词】黄色肉芽肿性胆囊炎;诊断;治疗【Abstract】Objective:To di
3、scus the diagnosis and treatment of xanthogranulomatous cholecystitis.Methods:Retrospective analysis was carried out for the clinical materials of 26 cases of xanthogranulomatous cholecystitis from January 2000 to now.Results:22 patients were followed up,the rate was 84.6%,all were alive.All the pat
4、ients received B ultrasonic examination,16 of whom were diagnosed,the rate was 61.5%,6 patients received CT scan,4 patients received MRI scan,1 patient received PET-CT examination,18 patients were diagnosed by combined iconography examination,the rate was 69.2%,8 patients were misdiagnosised as gall
5、bladder carcinoma,the rate was 30.8%,all the misdiagnosised patients were finally diagnosed through the quick pathologic test.20 patients were treated with cholecystectomy,among them 16 of whom were tried to be treated with laparoscopic cholecystectomy,10 patients were tranfer cholecystectomy,the ra
6、te of tranfer was 62.5%,2 patients were treated with cholecystectomy and spheno-hepatectomy,4 patients were treated with cholecystectomy and common bile duct plastic surgery and T tube drainage.3 patients happened with bile leak,1 patient with abdominal bleeding,2 patients with wound infection,the c
7、omplication rate of w as 23.1%,the death rate was 0%.Conclusions:The differentiation of XGC and gallbladder cancer was difficult before the operation,pathological examination during the operation can decress the misdiagnosis rate,cholecystectomy is the first choice of operation type,the laparoscopic
8、 cholecystectomy can be chosen,the tranfer cholecystectomy rate is obviously higher than the common cholecystitis,the common bile duct plastic surgery can be taken if patients compare with Mirizzi syndrome,the extended resection should be avoided expect for those that gallbladder cancer can not be e
9、xcluded.【Key Word】XGC;Diagnosis;Treatment 黄色肉芽肿性胆囊炎(xanthogranulomatous cholecystitis,XGC)是一种临床较少见的良性胆囊病变,由于与胆囊癌有类似侵犯周围组织的表现,易与周围组织形成致密粘连,且影像学检查往往可见胆囊内占位性病变或胆囊壁增厚,给临床的诊断及治疗带来一定得困难,本文就我院收治的 26 例 XGC 的临床资料,探讨 XGC 的一些诊治要点。1 资料与方法 1.1 一般资料:本组共 26 例,男性 16 例,女性 10 例,男女之比 1.6:1,年龄 24-71 岁,中位年龄 56 岁。随访 22 例
10、无恶变。1.2 临床表现:主要表现与胆囊结石及胆囊炎类似,为右上腹痛,共有 20 例,其中有 16 例为急性发作,占 61.5,形成 Mirizzi综合症导致胆管狭窄并出现黄疸者 4 例,占 15.4,体检发现胆囊占位而无症状者 6 例。1.3 诊断方法:行 B 超检查者 26 例,行 CT 检查 6 例,行 MRI检查 4 例,行 PET-CT 检查者 1 例。B 超检查诊断胆囊结石或胆囊炎者 16 例,占 61.5%。B 超联合其余影像学检查诊断为胆囊结石者 18例,诊断符合率 69.2,诊断为胆囊占位者 8 例,误诊率 30.8,8例术前诊断胆囊占位患者经术中病理检查后均排除胆囊癌可能。
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- 黄色 肉芽肿 胆囊炎 诊治 分析
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