摘要： 目的 探讨黄色肉芽肿性胆囊炎（XGC）与胆囊癌（GBC）的临床特点，为二者的鉴别诊断提供参考。方法 回顾性分析我院2009年12月至2017年12月病理诊断明确且临床资料齐全的16例XGC患者和62例GBC患者，比较2组患者的临床表现、实验室检查结果、影像学表现和术中所见方面的差异。结果 临床表现：2组比较，食欲和体质量下降的发生率有统计学差异（P<0.05），腹痛、黄疸、发热的发生率无统计学差异（P>0.05）。实验室检查结果：2组患者白细胞、丙氨酸转氨酶、天冬氨酸转氨酶、癌胚抗原以及糖类抗原19-9均高于正常上限值，但2组比较上述指标无统计学差异（P>0.05）。影像学表现：2组比较，胆囊结石、胆囊炎的发生率有统计学差异（P<0.05）；2组患者均存在胆囊壁增厚，XGC患者以弥漫性增厚为主，GBC患者以局限性增厚为主，2组比较，胆囊壁增厚方式的差异有统计学意义（P<0.05）。2组术中所见比较，胆囊结石、胆囊壁水肿和肝门淋巴结肿大的发生率有统计学差异（P<0.05）。结论 XGC与GBC术前鉴别有一定困难，影像学检查可以为鉴别二者提供线索，术中冰冻和术后病理必不可少，确诊有赖于术后病理。

黄色肉芽肿性胆囊炎与胆囊癌的临床对比分析

宋从浩¹, 马刚¹, 刘哲¹, 王丹璞²

1. 中国医科大学附属第一医院胰胆外科, 沈阳 110001;
2. 首都医科大学附属北京地坛医院普外科, 北京 100015

收稿日期:2019-11-19出版日期:2020-11-30发布日期:2020-10-31
通讯作者:马刚E-mail:magangzy@163.com
作者简介:宋从浩(1992-),男,医师,硕士.



关键词: 黄色肉芽肿性胆囊炎, 胆囊癌, 胆囊结石, 胆囊炎, 临床分析, 鉴别诊断
Abstract: Objective To explore the clinical features of xanthogranulomatous cholecystitis(XGC)and gallbladder cancer(GBC)and provide a guideline for differential diagnosis. Methods In this study,16 XGC patients and 62 GBC patients with clear pathological diagnosis and complete clinical data who were admitted to our hospital from December 2009 to December 2017 were retrospectively analyzed. The clinical manifestations,laboratory tests results,imaging findings,and intraoperative findings of the two groups were compared. Results There were significant differences in the incidences of decreased appetite and weight loss between the two groups,but no statistical difference was found in the incidences of abdominal pain,jaundice,and fever. White blood cells,alanine aminotransferase, aspartate aminotransferase,carcinoembryonic antigen,and carbohydrate antigen 19-9 were all higher than normal in the two groups,but there was no statistical difference between the two groups. The incidences of cholestolithiasis and cholecystitis were statistically different between the two groups. Gallbladder wall thickening was found in both groups;mainly diffuse thickening in XGC group and localized thickening in GBC group. The incidences of cholestolithiasis,gallbladder wall edema,and hilar lymphadenopathy were statistically different between the two groups. Conclusion The preoperative differential diagnosis of XGC and GBC is difficult. Imaging examination can provide clues regarding differential diagnosis. Intraoperative frozen section and postoperative pathological examination are essential, and the diagnosis depends on postoperative pathological findings.
Key words: xanthogranulomatous cholecystitis, gallbladder carcinoma, cholestolithiasis, cholecystitis, clinical analysis, differential diagnosis
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