摘要
目的 提高黄色肉芽肿性胆囊炎（ｘａｎｔｈｏｇｒａｎｕｌｏｍａｔｏｕｓ ｃｈｏｌｅｃｙｓｔｉｔｉｓ ， Ｘ Ｇ Ｃ） 的诊治水平。方法 回顾性总结１９８８ 年１ 月至１９９７ 年１ 月本院经病理诊断的３８ 例黄色肉芽肿性胆囊炎的临床资料。 结果 ３８ 例黄色肉芽肿性胆囊炎占同期１ ５８３ 例胆囊切除术的２４ ％ ，术前均未作出明确诊断，３８ 例均有右上腹疼痛史，其中３１ 例有压痛，８ 例扪及肿大胆囊，１０ 例有不同程度的恶心、呕吐，黄疸及发烧分别为１４ 例及８ 例， Ｂ 型超声均见胆囊结石、胆囊壁增厚。术前诊断为胆囊炎或胆囊结石者３３例，诊断为胆囊癌者５ 例。肉眼观察局限型胆囊炎２１ 例，壁内可见黄绿色结节，弥漫型胆囊炎１７ 例，可见融合成片状或布满整个胆囊之结节，５ 例侵及肝、十二指肠等邻近器官。手术方式：单纯胆囊切除２２ 例，附加胆总管取石、 Ｔ 管引流１１ 例，加肝楔形切除３ 例，胆囊大部切除、造瘘加肝段切除２ 例。术后３４ 例随访１ ～１０ 年，在加行胆总管切开取石的１０ 例中，１ 例术后３ 年因胆总管复发结石，再次行胆总管切开取石术。无近期、远期并发症。 结论 Ｘ Ｇ Ｃ 是一种特殊类型的胆囊炎，临床表现不典型，术前难以诊断。 Ｂ 型超声提?
Objective To improve the diagnosis and treatment of xanthogranulomatous cholecystitis (XGC). Method 38 cases of XGC were found in 1583 cholecystectomies (2 4%) performed in our hospital. Results None of these patients were correctly diagnosed preoperatively.Preoperative diagnosis was cholecystitis with gall stones in 33 cases,and gallbladder carcinoma in 5.The upper right quadrant pain was complained in all cases accompanied by nausea and vomitting. Jaundice was presented in 14 cases and fever in 13.Ultrasound found gallstones and thickness of the wall of the gallbladder in all cases. In five patients xanthogranulomatous tissue invaded into adjecent hepatic parenchyma,and duodenum. Microscopic examination showed the typical presence of foam cells in nodules characteristic of XGC.Cholecystectomy was performed in 22 cases.Cholecystectomy plus choledocholithotomy and drainage in 11 cases, hepatic wedged resection in 3.Subtotal cholecystectomy plus stump cholecystostomy and hepatic segment resection were performed in 2 cases. Conclusions Being without a typical clinical presentation XGC is difficult to diagnose preoperatively.Diffuse wall thickening would suggest a diagnosis of XGC.Histopathology of the gallbladder is the mainstay of the diagnosis.Cholecystectomy is generally a cure for the disease and good result could be anticipated in almost all patients.
出处
《中华普通外科杂志》
CSCD
1999年第5期338-340,共3页
Chinese Journal of General Surgery
