术中冰冻检查在诊断黄色肉芽肿性胆囊炎中的作用

目的探讨术中冰冻切片检查在诊断黄色肉芽肿性胆囊炎(xanthogranu lom atous cholecystitis,XGC)中的作用。方法统计我院10年间确诊XGC的33例病例,其中9例行术中冰冻切片检查。结果9例患者术前均行B超及CT检查,术前诊断为慢性结石性胆囊炎3例,胆囊癌5例,胆囊占位1例。所有患者的术中所见均有胆囊壁明显增厚,胆囊与肝脏胆囊床面、大网膜等周围组织明显粘连。行术中冰冻切片检查后,快速病理回报提示,3例明确诊断XGC,4例为慢性胆囊炎性病变,2例提示胆囊壁蜂窝组织炎样改变。4例行胆囊切除术,4例行部分胆囊切除术,1例行胆囊癌根治术。术后病理均诊断为XGC。结论XGC是一种特殊类型的慢性胆囊炎性病变,在临床上非常少见。胆囊慢性炎症使胆囊壁增厚,并与肝脏或临近组织粘连浸润,影像学上和大体上易误诊为胆囊癌。确诊XGC需依赖病理检查。术中冰冻切片检查可明确病变性质,排除胆囊恶性病变,对手术方式的选择有直接影响,避免了术中盲目扩大切除的可能。

INTRAOPERATIVE FROZEN-SECTION EXAMINATION IN DIAGNOSIS OF XANTHOGRANULOMATOUS CHOLECYSTITIS

Objective To investigate the role of intraoperative frozen-section examination in the by diagnosis of Xanthogranulomatous cholecystitis(XGC).Methods Frozen-section examination were adopted in 9 of 33 patients with XGC which diognosis was definited by pathological examination among 10 years.The data from these 9 patients were analysed retrospectively.Results All of patients were examined with ultrasound and computed tomography(CT).3 cases of chronic calculous cholecystitis,5 cases of carcinoma of gallbladder,and 1 case of gallbladder occupying lesion were included in preoperative diagnosis.In the operations of these patients,thickening of the gallbladder wall was found in all of the patients;xanthogranulomatous tissues were found its invading into other tissues,such as gallbladder bed and omentum majus,et al.The diagnosis of frozen-section examination was 3 of XGC,4 of chronic cholecystic inflammatory lesions,and 2 of phlegmonous cholecystitis.Open cholecystectomy was performed on 4 cases,4 cases were suffered to partial cholecystectomy,and 1 cases suffered to carcinoma of gallbladder radical correction.XGC was definitely diagnosed by postoperative pathological examination in all of patients.Conclusions XGC is a rare and special type of chronic cholecystitis.Owing to thickening of the gallbladder wall,and firm adhesions to liver or other neighboring tissues induced by cholecystic chronic inflammation,XGC is easy to mimic carcinoma of gallbladder in imaging and in gross.Definite diagnosis depends on pathological examination.Intraoperative frozen-section examination can identify the characters of lesion,rule out diagnosis of carcinoma of gallbladder,make direct effect on the choice of modus operandi,and avoid the possibility of enlarged resection blindly intraoperatively.