黄色肉芽肿性胆囊炎腹腔镜诊治研究.docVIP

黄色肉芽肿性胆囊炎腹腔镜诊治研究摘 要 目的：探讨黄色肉芽肿性胆囊炎（XGC）的腹腔镜诊治方法。方法：回顾性分析1990年1月-2011年9月间诊治的23例XGC患者临床资料。结果：23例XGC中合并胆囊结石的22例，术前诊断为XGC的仅2例，误诊为胆囊癌的6例。术中均见胆囊与周围组织粘连，胆囊十二指肠内瘘5例；术中均行冰冻切片检查，确诊16例；成功完成腹腔镜胆囊切除术（LC）17例，其中行胆囊次全切除5例；中转开腹6例，中转开腹率26.1%。所有病例均治愈，术后平均住院天数7.9天。结论：XGC是一种少见的特殊类型的胆囊炎，术前易与胆囊癌混淆，确诊须依靠病理切片，手术切除胆囊是最佳的治疗途径。虽然LC手术难度大、中转率高，但仍可作为治疗XGC的优先选择。 关键词 黄色肉芽肿性胆囊炎 胆囊切除术 腹腔镜 中图分类号：R657.4 文献标识码：C 文章编号：1006-1533（2012）12-0023-03 Analysis of the laparoscope diagnosis and treatment of xanthogranulomatous cholecystitis WANG Wei1, LINAG Chun-li1, BAO Yan-yi2 (1. General Surgery Department of Eastern Hospital affiliated Tongji University, Shanghai, 2001200; 2. Surgery Department of the Traditional Chinese Medicine Hospital of Minghang District, Shanghai, 201103) ABSTRACT Oubject: To investigate the diagnosis and treatment of xanthogranulomatous cholecystitis(XGC) with laparoscope. Method: The clinical data of 23 patients with XGC treated with laparoscope from Jan. 1990 to Sept 2011 were analyzed retrospectively. Results: Of 23 patients with XGC, 22 combined with calculus, only 2 of them were diagnosed preoperatively, and 6 of them were misdiagnosed as gallbladder cancer. Severe adhesion between gallbladder and surrounding tissues could be seen intra-operatively. Cholecystoduodenal fistula exited in 5 patients. Frozen section examination was done in all patients intra-operatively and confirmed diagnosis was done in 16 patients. Laparoscopic cholecystectomy was performed successfully in 17 patients and subtotal cholecystectomy was done in 5 of them. 6 patients were transferred to open cholecystectomy. All patients cured and the average hospitalized days were 7.9. Conclusion: XGC was an unusual type of cholecystitis, which was easy to mis-diagnosed with gallbladder cancer and confirmed diagnosis could be done by pathology. Cholecystectomy was the best way of surgical management. Laparoscopic cholecystectomy was of first choice in surgical management in patients with XGC. KEY WORDS xa