Diagnosis And Treatment Of 117 Cases Of Xanthogranulomatous Cholecystitis

ObjectiveTo investigate the clinical characteristics,diagnosis and treatment of patients with Xanthogranulmatous cholecystitis(XGC).MethodsThe clinical data of 117 patients with XGC who underwent surgical resection and confirmed by pathology in the First Affiliated Hospital of Nanchang University from May 2014 to November 2021 were retrospectively analyzed.ResultsThere were 69 males and 48 females,with an average age of 53.4 years(17 – 80years).There was no difference between XGC and chronic cholecystitis.XGC often showed upper abdominal pain with radiation pain(88.03 %),nausea(51.28 %)and fever(21.36 %).Tumor markers were detected in all patients,of which 117 cases were negative for CEA and 40 cases(34.18 %)were abnormal for CA199.All patients received at least one imaging examination before operation,including 117 cases of B-ultrasound,37 cases of upper abdominal CT scan + enhancement,and 15 cases of upper abdominal MRI.Before operation,86 cases of gallbladder stones with chronic cholecystitis,7 cases of gallbladder space occupying,2 cases of gallbladder adenomyosis,1 case of gallbladder cancer,20 cases of gallbladder stones with common bile duct stones,and 1 case of intrahepatic bile duct stones with gallbladder stones were diagnosed.including 96 patients underwent laparoscopic cholecystectomy(LC)(15 patients underwent retrograde cholangiopancreatography or endoscopic sphincterotomy),10 patients were converted to open cholecystectomy(10.4 %),7patients underwent open cholecystectomy(OC)(5 patients underwent OC +common bile duct exploration,1 patient underwent T-tube drainage,and 4 patients underwent primary suture of common bile duct),and 2 patients underwent cholecystectomy + wedge resection of liver.1 case underwent cholecystectomy +wedge resection of liver + partial resection of colon,1 case underwent cholecystectomy + choledochojejunostomy,the average amount of bleeding was 80.6ml(5 ml-400 ml),the average length of hospital stay was 9.2 d(5 d-28 d).There were 6 cases of total complications,including 1 case of postoperative abdominal hemorrhage,4 cases of abdominal infection,and 1 case of biliary tract hemorrhage.Abdominal hemorrhage and biliary tract hemorrhage were treated with interventional therapy.After conservative treatment,10 cases were converted to open surgery.Among them,7 cases had severe adhesion around the gallbladder,which could not be separated from the surrounding organs,and the gallbladder triangle was blurred.Three cases had blurred surgical vision due to intraoperative bleeding.Conclusions:XGC is a special type of chronic cholecystitis in clinic,and its clinical manifestations are nonspecific.XGC is similar to general cholecystitis,gallbladder adenoma,gallbladder carcinoma and other diseases,and imaging diagnosis is difficult.The gold standard for diagnosis depends on pathology,including intraoperative freezing or postoperative pathology.The treatment of yellow granulomatous cholecystitis is mainly cholecystectomy,should not blindly expand the scope of surgical resection,still dominated by minimally invasive surgery management.