王炜 梁春立 包炎毅

摘 要 目的：探讨黄色肉芽肿性胆囊炎（XGC）的腹腔镜诊治方法。方法：回顾性分析1990年1月-2011年9月间诊治的23例XGC患者临床资料。结果：23例XGC中合并胆囊结石的22例，术前诊断为XGC的仅2例，误诊为胆囊癌的6例。术中均见胆囊与周围组织粘连，胆囊十二指肠内瘘5例；术中均行冰冻切片检查，确诊16例；成功完成腹腔镜胆囊切除术（LC）17例，其中行胆囊次全切除5例；中转开腹6例，中转开腹率26.1%。所有病例均治愈，术后平均住院天数7.9天。结论：XGC是一种少见的特殊类型的胆囊炎，术前易与胆囊癌混淆，确诊须依靠病理切片，手术切除胆囊是最佳的治疗途径。虽然LC手术难度大、中转率高，但仍可作为治疗XGC的优先选择。

关键词黄色肉芽肿性胆囊炎胆囊切除术腹腔镜

中图分类号：R657.4文献标识码：C文章编号：1006-1533（2012）12-0023-03

Analysis of the laparoscope diagnosis and treatment of xanthogranulomatous cholecystitis

WANG Wei1, LINAG Chun-li1, BAO Yan-yi2

(1. General Surgery Department of Eastern Hospital affiliated Tongji University, Shanghai, 2001200; 2. Surgery Department of the Traditional Chinese Medicine Hospital of Minghang District, Shanghai, 201103)

ABSTRACTOubject: To investigate the diagnosis and treatment of xanthogranulomatous cholecystitis(XGC) with laparoscope. Method: The clinical data of 23 patients with XGC treated with laparoscope from Jan. 1990 to Sept 2011 were analyzed retrospectively. Results: Of 23 patients with XGC, 22 combined with calculus, only 2 of them were diagnosed preoperatively, and 6 of them were misdiagnosed as gallbladder cancer. Severe adhesion between gallbladder and surrounding tissues could be seen intra-operatively. Cholecystoduodenal fistula exited in 5 patients. Frozen section examination was done in all patients intra-operatively and confirmed diagnosis was done in 16 patients. Laparoscopic cholecystectomy was performed successfully in 17 patients and subtotal cholecystectomy was done in 5 of them. 6 patients were transferred to open cholecystectomy. All patients cured and the average hospitalized days were 7.9. Conclusion: XGC was an unusual type of cholecystitis, which was easy to mis-diagnosed with gallbladder cancer and confirmed diagnosis could be done by pathology. Cholecystectomy was the best way of surgical management. Laparoscopic cholecystectomy was of first choice in surgical management in patients with XGC.

KEY WORDSxanthogranulomatous cholecystitis;cholecystectomy；laparoscope

黄色肉芽肿性胆囊炎（xanthogranulomatous cholecystitis，XGC）是一种临床少见的特殊类型的胆囊炎。由于其临床表现缺乏特异性，且尚无理想的术前检查和确诊手段，导致临床医生对其认识不足，术前能确诊的也较少。本文分析自1990年1月至2011年9月期间23例XGC行腹腔镜手术治疗的临床资料，报告如下。

1资料与方法

1.1资料

1990年1月～2011年9月间诊治的23例黄色肉芽肿性胆囊炎临床资料，其中男9例，女14例。年龄42～76岁，年龄中位数尾59.6岁。

1.2方法

采取回顾性分析方法，对23例XGC病例的临床表现、术前诊断、手术方法、治疗结果进行分析。

2结果

2.1临床表现

23例患者中，急性发病16例，其中急性胆囊炎9例、急性胆管炎5例、急性胆源性胰腺炎2例；慢性起病7例。发病时伴有黄疸7例。……