Yang W G, Wang S S, Weng Y J, Tsay S H, Chen C C, Chiang J H, Su C H, Lee F Y, Lee S D
Department of Medicine, Veterans General Hospital-Taipei, Taiwan, R.O.C.
Zhonghua Yi Xue Za Zhi (Taipei). 1996 Jul;58(1):12-7.
Adenomyomatosis of the gallbladder in Chinese patients has rarely been analyzed.
The clinical, radiological and pathological features of 18 patients with histologically-proven adenomyomatosis, collected during a 5-year period, were retrospectively analyzed.
According to the extent and site of involvement, adenomyomatosis of the gallbladder was conventionally classified into three types: localized, generalized and segmental. In our series, the disease was localized in 17 patients (15 in the fundus and 2 in the neck), generalized in one patient and segmental in none. Only 5 patients showed sonographic features correlative to pathologic findings, and 2 of them were correctly diagnosed before operation. Only mild nonspecific abnormalities of liver function test or urine analysis were noted in some patients with gallbladder adenomyomatosis. The clinical manifestations were not related to coincidental diseases in 11 patients. All these 11 patients, with gallstone in 9 and without in 2, complained of epigastralgia, right upper quadrant abdominal pain or dyspepsia, which relieved all after cholecystectomy.
Some patients with adenomyomatosis may be symptomatic and relieved by cholecystectomy. In patients with adenomyomatosis of the gallbladder and right upper quadrant pain of abdomen without other explanation, cholecystectomy may be considered. Infrequent accurate diagnosis in Chinese patients calls for a high suspicion of the disease entity in clinical practice.
很少对中国患者的胆囊腺肌症进行分析。
回顾性分析5年间收集的18例经组织学证实为胆囊腺肌症患者的临床、影像学和病理学特征。
根据受累范围和部位，胆囊腺肌症传统上分为三型：局限型、弥漫型和节段型。在我们的病例系列中，17例患者为局限型（15例位于胆囊底部，2例位于颈部），1例为弥漫型，无节段型。仅5例患者的超声特征与病理结果相关，其中2例在术前得到正确诊断。部分胆囊腺肌症患者仅出现肝功能检查或尿液分析的轻度非特异性异常。11例患者的临床表现与合并疾病无关。这11例患者中，9例有胆囊结石，2例无胆囊结石，均主诉上腹部疼痛、右上腹腹痛或消化不良，胆囊切除术后症状均缓解。
部分胆囊腺肌症患者可能有症状，胆囊切除术后症状可缓解。对于胆囊腺肌症且有右上腹腹痛而无其他原因解释的患者，可考虑行胆囊切除术。中国患者中诊断准确性不高，临床实践中需要高度怀疑该病。
