摘要
目的 对比分析轻-中型黄色肉芽肿性胆囊炎（Xanthogranulomatous cholecystitis,XGC）与重型XGC的临床特征及手术结果，为临床XGC诊治提供参考。方法 回顾性分析2021年1月至12月手术并经病理学证实为XGC患者的临床资料，根据术前诊断是否为XGC或GBC疑诊分为轻-中型XGC组（n=83）和重型XGC组(n=40)，使用SPSS 25.0软件对比分析两组临床资料之间的差异。结果 一般情况：重型XGC的平均年龄及总住院时间高于轻-中型XGC（P＜0.05）；临床表现：两组临床表现均无统计学差异（P＞0.05）；实验室检查：重型XGC的PLR、ALP较轻-中型XGC高（P＞0.05），而ALB、A/G、HDL-C低于轻-中型XGC（P＜0.05）；影像学表现：重型XGC以胆囊壁不均匀型增厚为主，MRI检查时更易出现低信号影（P＜0.05）；手术指标：重型XGC较轻-中型XGC的手术时间更长、出血量多、切除范围广、中转开腹率高（P＜0.05）。结论 XGC是一种罕见的胆囊炎性疾病，有轻重之分，可综合术前各项指标对其分型：轻-中型XGC可视为普通型胆囊炎，可选择腹腔镜胆囊切除术；重型XGC难与GBC相鉴别，且中转开腹率较高，可考虑开腹手术，并联合术中冰冻检查，避免不必要的扩大切除。
关键词： 黄色肉芽肿性胆囊炎；分型；症状；实验室检查；腹腔镜；开腹
Abstract
Objective The clinical features and surgical results of mild to moderate xanthogranulomatous cholecystitis (Xanthogranulomatous cholecystitis, XGC) and severe XGC were compared and analyzed in order to provide reference for clinical diagnosis and treatment of XGC. Methods The clinical data of patients with XGC confirmed by pathology from January to December in 2021 were retrospectively analyzed. According to whether they were diagnosed as XGC or GBC before operation, they were divided into mild to moderate XGC group (n=83) and severe XGC group (n=40). The difference of clinical data between the two groups was compared and analyzed by SPSS25.0 software. Result General information, the average age and total hospitalization time of severe XGC were higher than those of mild-moderate XGC(P＜0.05), and there was no significant difference in clinical manifestations between the two groups(P＞0.05). Laboratory examination showed that PLR and ALP in severe XGC were higher than those in mild-medium XGC, while ALB, A/G and HDL-C were lower than those in mild-medium XGC(P＜0.05). The imaging findings showed that inhomogeneous thickening of gallbladder wall was the main manifestation in severe XGC, and low signal shadow was more likely to be seen in MRI examination. Surgical indicators: compared with mild-medium XGC, severe XGC had longer operation time, more bleeding, wider scope of resection and higher rate of conversion to laparotomy(P＜0.05). Conclusion XGC is a rare cholecystic inflammatory disease, which can be classified according to various preoperative indexes: mild to moderate XGC can be regarded as common cholecystitis and can be selected for laparoscopic cholecystectomy; severe XGC is difficult to distinguish from GBC, and the rate of conversion to laparotomy is high, so laparotomy can be considered combined with intraoperative freezing examination to avoid unnecessary extended resection.
Key words： Xanthogranulomatous cholecystitis; typing; symptoms; laboratory examination; laparoscopy; laparotomy
参考文献 References
[1] 林建华, 池出淮, 王继生, et al. 黄色肉芽肿性胆囊炎42例临床诊疗分析. 中华普通外科杂志. 2021;36(06):470-1.
[2] McCoy JJ, Jr., Vila R, Petrossian G, et al. Xanthogranulomatous cholecystitis. Report of two cases. J S C Med Assoc. 1976;72(3):78-9.
[3] Nakashiro H, Haraoka S, Fujiwara K, et al. Xanthogranulomatous cholecystis. Cell composition and a possible pathogenetic role of cell-mediated immunity. Pathol Res Pract. 1995;191(11):1078-86.
[4] Nacif LS, Hessheimer AJ, Rodríguez Gómez S, et al. Infiltrative xanthogranulomatous cholecystitis mimicking aggressive gallbladder carcinoma: A diagnostic and therapeutic dilemma. World J Gastroenterol. 2017;23(48):8671-8.
[5] Feng L, You Z, Gou J, et al. Xanthogranulomatous cholecystitis: experience in 100 cases. Annals of translational medicine. 2020;8(17):1089.
[6] Imokawa T, Ito K, Takemura N, et al. Xanthogranulomatous Pancreatitis Accompanied by Xanthogranulomatous Cholecystitis: A Case Report and Literature Review. Pancreas. 2021;50(7):1037-41.
[7] Hong SA, Sung YN, Kim HJ, et al. Xanthogranulomatous cholecystitis shows overlapping histological features with IgG4-related cholecystitis. Histopathology. 2018;72(4):569-79.
[8] Jearth V, Patil P, Patkar S, et al. Immunoglobulin G4-related cholecystitis mimicking a locally advanced gallbladder cancer-a case report and review of literature. Clin J Gastroenterol. 2020;13(5):806-11.
[9] Zhou QM, Liu CX, Zhou JP, et al. Machine Learning-Based Radiological Features and Diagnostic Predictive Model of Xanthogranulomatous Cholecystitis. Front Oncol. 2022;12:792077.
[10] Rajaguru K, Mehrotra S, Lalwani S, et al. New scoring system for differentiating xanthogranulomatous cholecystitis from gall bladder carcinoma: a tertiary care centre experience. ANZ J Surg. 2018;88(1-2):E34-e9.
[11] Bo X, Chen E, Wang J, et al. Diagnostic accuracy of imaging modalities in differentiating xanthogranulomatous cholecystitis from gallbladder cancer. Annals of translational medicine. 2019;7(22):627.
[12] Hijioka S, Mekky MA, Bhatia V, et al. Can EUS-guided FNA distinguish between gallbladder cancer and xanthogranulomatous cholecystitis? Gastrointest Endosc. 2010;72(3):622-7.
[13] Hijioka S, Nagashio Y, Ohba A, et al. The Role of EUS and EUS-FNA in Differentiating Benign and Malignant Gallbladder Lesions. Diagnostics (Basel, Switzerland). 2021;11(9).
[14] Manohar K, Mittal BR, Bhattacharya A, et al. Intense FDG activity in a case of xanthogranulomatous cholecystitis without elevated fluorothymidine activity. Clin Nucl Med. 2013;38(4):e205-6.
[15] Zhang Z, Dong H, Zhang L, et al. Xanthogranulomatous Cholecystitis Masquerading as Gallbladder Carcinoma on 68Ga-FAPI-04 PET. Clin Nucl Med. 2022.
[16] Park JW, Kim KH, Kim SJ, et al. Xanthogranulomatous cholecystitis: Is an initial laparoscopic approach feasible? Surg Endosc. 2017;31(12):5289-94.
[17] Makimoto S, Takami T, Hatano K, et al. Xanthogranulomatous cholecystitis: a review of 31 patients. Surg Endosc. 2021;35(7):3874-80.
[18] Güneş Y, Bostancı Ö, İlbar Tartar R, et al. Xanthogranulomatous Cholecystitis: Is Surgery Difficult? Is Laparoscopic Surgery Recommended? J Laparoendosc Adv Surg Tech A. 2021;31(1):36-40.
[19] Domínguez-Comesaña E, Tojo-Artos I, Domínguez-Fernández R, et al. Clinical Outcomes of Elective Laparoscopic Cholecystectomy: Retrospective Comparative Study Between Patients With and Without Xanthogranulomatous Cholecystitis. Surg Laparosc Endosc Percutan Tech. 2019;29(3):212-5.
[20] Bolukbasi H, Kara Y. An Important Gallbladder Pathology Mimicking Gallbladder Carcinoma: Xanthogranulomatous Cholecystitis: A Single Tertiary Center Experience. Surg Laparosc Endosc Percutan Tech. 2020;30(3):285-9.
[21] Azari FS, Kennedy GT, Bormann B, et al. A contemporary analysis of xanthogranulomatous cholecystitis in a Western cohort. Surgery. 2021;170(5):1317-24.
[22] Deng YL, Cheng NS, Zhang SJ, et al. Xanthogranulomatous cholecystitis mimicking gallbladder carcinoma: An analysis of 42 cases. World J Gastroenterol. 2015;21(44):12653-9.
[23] Khan S, Abeer I, Husain M, et al. Xanthogranulomatous cholecystitis mimicking advanced gallbladder carcinoma - Analysis of 8 cases. J Cancer Res Ther. 2021;17(4):969-75.