Barcia Juan José
Cátedra de Anatomía Patológica, Hospital de Clínicas Dr Manuel Quintela, Facultad de Medicina, Montevideo, Uruguay.
Ann Diagn Pathol. 2003 Jun;7(3):147-53. doi: 10.1016/s1092-9134(03)00011-x.
Cholecystectomy is one of the most common surgical procedures. Inflammatory disease is by far the most common pathology of the gallbladder. Terms for describing cholecystitis are numerous, thus there is no uniform terminology. One hundred cholecystectomies and 10 gallbladders from autopsies were reviewed and inflammatory changes were analyzed. Chronic cholecystitis was seen in 75% of cases with epithelial metaplasia and 73% with regenerative epithelium, the latter being associated with erosion but not with the presence of lithiasis. Muscular thickening and adipose deposits were mostly mild. Inflammation was mild in 28%, moderatein 57%, and severe in 15%. Activity was found in 29% of cases. Fibrosis was present in all cases: 26% mild, 62% moderate, and 12% severe. Autopsy cases did not show significant changes. A simple and reproducible scoring system of inflammation and fibrosis of the gallbladder is proposed. Three numbers refer to mild, moderate, or severe degrees of chronic inflammation and activity, with a final score that results from adding both values. The fibrosis is classified in three different stages. The final report uses both values to classify the chronic cholecystitis. A scoring system for chronic cholecystopathy to replace descriptive terms would give an exact transduction of the observed changes in an objective fashion that could not be misinterpreted by physicians or other pathologists.
胆囊切除术是最常见的外科手术之一。炎症性疾病是迄今为止胆囊最常见的病理状况。描述胆囊炎的术语众多，因此没有统一的术语。回顾了100例胆囊切除术病例以及10例尸检胆囊，并分析了炎症变化。75%的病例可见慢性胆囊炎伴有上皮化生，73%伴有再生上皮，后者与糜烂相关，但与结石存在无关。肌肉增厚和脂肪沉积大多较轻。28%的病例炎症为轻度，57%为中度，15%为重度。29%的病例存在活动度。所有病例均有纤维化：26%为轻度，62%为中度，12%为重度。尸检病例未显示明显变化。提出了一种简单且可重复的胆囊炎症和纤维化评分系统。三个数字分别代表慢性炎症和活动度的轻度、中度或重度，最终得分是两者相加的结果。纤维化分为三个不同阶段。最终报告使用这两个值对慢性胆囊炎进行分类。用一个慢性胆囊病评分系统取代描述性术语，将以一种客观的方式准确转化观察到的变化，医生或其他病理学家不会对其产生误解。
