厚壁胆囊：一种实用的管理方法。

Thick-walled Gallbladder: A Pragmatic Management Approach.

作者信息

Ganaie Ishtiyaq Ahmad, Manzoor Sadatul, Qadri Arshid Iqbal, Bhat Gowhar Aziz

机构信息

Department of General & Minimal Access Surgery, Government Medical College, Srinagar, Jammu and Kashmir, India.

Department of General and Minimal Invasive Surgery, Sher-I-Kashmir Institute of Medical Sciences Soura, Srinagar, Jammu and Kashmir, India.

出版信息

Euroasian J Hepatogastroenterol. 2024 Jul-Dec;14(2):191-197. doi: 10.5005/jp-journals-10018-1451. Epub 2024 Dec 27.

DOI:10.5005/jp-journals-10018-1451

PMID:39802847

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11714112/

Abstract

INTRODUCTION

Thick-walled gallbladder (TWGB) is a common yet non-specific radiological finding associated with a wide range of gallbladder pathologies, including acute and chronic inflammation, infection, and malignancy. Among the inflammatory causes, xanthogranulomatous cholecystitis (XGC) is a rare but significant condition that often mimics gallbladder carcinoma. This paper presents a pragmatic approach to the diagnosis and management of TWGB, focusing on the complexities posed by XGC. Detailed analysis of imaging techniques, surgical strategies, and histopathological findings is provided to guide clinical decision-making.

OBJECTIVE

This paper presents a pragmatic approach to the diagnosis and management of TWGB, with a particular focus on the complexities posed by XGC mimicking a gallbladder mass in operated patients of TWGB in a tertiary care center over 2 years. Detailed analysis of imaging techniques, surgical strategies, and histopathological findings is provided to guide clinical decision-making.

STUDY DESIGN

We had 18 patients of TWGB, 14 males (77.7%) and 4 females (22.2%) who were a part of the prospective study. All cases underwent anticipatory extended cholecystectomy (AEC) with frozen section assessment during the period of 2 years. All these cases were evaluated with ultrasound, triple-phase CT followed by MR/MRCP, and CA 19-9 levels as outlined in the flowchart.

RESULTS

In this study out of 18 patients who underwent AEC the frozen section of 15 cases of patients was reported as XGC, and 3 cases were reported as carcinoma GB with T1b stage and these 3 cases further underwent EC in the same setting. Out of 18 cases, 16 had an uneventful postop period and 2 cases developed complications Bile leak which was managed by pigtail drainage and bleeding managed by blood transfusions (Clavien-Dindo Classification-Grade III).

CONCLUSION

All TWGB are not carcinoma GB. Xanthogranulomatous cholecystitis is an important differential diagnosis for TWGB and, therefore, XGC should be considered in the differential diagnosis of TWGB.

HOW TO CITE THIS ARTICLE

Ganaie IA, Manzoor S, Qadri AI, Thick-walled Gallbladder: A Pragmatic Management Approach. Euroasian J Hepato-Gastroenterol 2024;14(2):191-197.

摘要

引言

厚壁胆囊（TWGB）是一种常见但非特异性的影像学表现，与多种胆囊病变相关，包括急慢性炎症、感染和恶性肿瘤。在炎症性病因中，黄色肉芽肿性胆囊炎（XGC）是一种罕见但重要的疾病，常酷似胆囊癌。本文提出了一种针对TWGB诊断和管理的实用方法，重点关注XGC带来的复杂性。提供了对成像技术、手术策略和组织病理学发现的详细分析，以指导临床决策。

目的

本文提出了一种针对TWGB诊断和管理的实用方法，特别关注在一家三级医疗中心2年期间接受手术的TWGB患者中，XGC酷似胆囊肿块所带来的复杂性。提供了对成像技术、手术策略和组织病理学发现的详细分析，以指导临床决策。

研究设计

我们有18例TWGB患者，其中14例男性（77.7%）和4例女性（22.2%），他们是前瞻性研究的一部分。在2年期间，所有病例均接受了预期扩大胆囊切除术（AEC）并进行了冰冻切片评估。所有这些病例均按照流程图中概述的方法进行了超声、三期CT检查，随后进行了MR/MRCP检查以及CA 19-9水平检测。