Deng Yi-Lei, Cheng Nan-Sheng, Zhang Shui-Jun, Ma Wen-Jie, Shrestha Anuj, Li Fu-Yu, Xu Fei-Long, Zhao Long-Shuan
Yi-Lei Deng, Shui-Jun Zhang, Fei-Long Xu, Long-Shuan Zhao, Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China.
World J Gastroenterol. 2015 Nov 28;21(44):12653-9. doi: 10.3748/wjg.v21.i44.12653.
To review and evaluate the diagnostic dilemma of xanthogranulomatous cholecystitis (XGC) clinically.
From July 2008 to June 2014, a total of 142 cases of pathologically diagnosed XGC were reviewed at our hospital, among which 42 were misdiagnosed as gallbladder carcinoma (GBC) based on preoperative radiographs and/or intra-operative findings. The clinical characteristics, preoperative imaging, intra-operative findings, frozen section (FS) analysis and surgical procedure data of these patients were collected and analyzed.
The most common clinical syndrome in these 42 patients was chronic cholecystitis, followed by acute cholecystitis. Seven (17%) cases presented with mild jaundice without choledocholithiasis. Thirty-five (83%) cases presented with heterogeneous enhancement within thickened gallbladder walls on imaging, and 29 (69%) cases presented with abnormal enhancement in hepatic parenchyma neighboring the gallbladder, which indicated hepatic infiltration. Intra-operatively, adhesions to adjacent organs were observed in 40 (95.2%) cases, including the duodenum, colon and stomach. Thirty cases underwent FS analysis and the remainder did not. The accuracy rate of FS was 93%, and that of surgeon's macroscopic diagnosis was 50%. Six cases were misidentified as GBC by surgeon's macroscopic examination and underwent aggressive surgical treatment. No statistical difference was encountered in the incidence of postoperative complications between total cholecystectomy and subtotal cholecystectomy groups (21% vs 20%, P > 0.05).
Neither clinical manifestations and laboratory tests nor radiological methods provide a practical and effective standard in the differential diagnosis between XGC and GBC.
从临床角度回顾和评估黄色肉芽肿性胆囊炎（XGC）的诊断难题。
回顾性分析2008年7月至2014年6月我院收治的142例经病理确诊的XGC患者，其中42例术前影像学检查及/或术中发现被误诊为胆囊癌（GBC）。收集并分析这些患者的临床特征、术前影像学表现、术中发现、冰冻切片（FS）分析及手术操作数据。
这42例患者中最常见的临床综合征为慢性胆囊炎，其次为急性胆囊炎。7例（17%）患者出现轻度黄疸，无胆总管结石。35例（83%）患者影像学检查显示增厚的胆囊壁内不均匀强化，29例（69%）患者胆囊邻近肝实质出现异常强化，提示肝脏浸润。术中，40例（95.2%）患者观察到与相邻器官粘连，包括十二指肠、结肠和胃。30例患者进行了FS分析，其余未进行。FS的准确率为93%，外科医生的宏观诊断准确率为50%。6例经外科医生宏观检查误诊为GBC并接受了积极的手术治疗。全胆囊切除术组和次全胆囊切除术组术后并发症发生率无统计学差异（21%对20%，P>0.05）。
临床表现、实验室检查及影像学方法均不能为XGC与GBC的鉴别诊断提供实用有效的标准。
