胆囊腺肌症的诊治:附205例报告
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朱继业, Email: gandanwk@vip.sina.com

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Diagnosis and treatment of gallbladder adenomyomatosis: a report of 205 cases
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    摘要:

    目的:探讨胆囊腺肌症的诊断和治疗方法。 方法:从北京大学人民医院病案数据库中检索2003年1月1日-2013年12月31日接受胆囊手术的患者资料,选取病理证实存在胆囊腺肌症的病例,回顾性分析各种影像学检查方法对胆囊腺肌症的正确诊断率、手术方式及效果。 结果:在6 336例胆囊手术患者中,病理证实存在205例(3.2%)胆囊腺肌症,其中195例(95.1%)合并慢性胆囊炎,150例(73.2%)合并胆囊结石。B超、CT、MRI的正确诊断率分别为16.2%、26.5%和43.8%。病变类型以局限型最多,为164例(80.0%),弥漫型和节段型相对较少,分别为16例(7.8%)和25例(12.2%)。178例(86.8%)接受了腹腔镜下胆囊切除手术,24例(11.7%)为传统开腹胆囊切除手术,未出现胆道损伤等并发症;3例接受了腹腔镜下胆囊部分切除手术。术后随访1年未发现胆囊腺肌症残留和复发病例。 结论:胆囊腺肌症多合并胆囊结石和胆囊炎,容易漏诊,MRI检查正确诊断率较高。对于位于胆囊底部的局限型病例,可考虑选择腹腔镜下胆囊部分切除手术治疗。

    Abstract:

    Objective: To discuss the diagnosis and treatment of adenomyomatosis of the gallbladder. Methods: The data of patients undergoing gallbladder surgery from January 2003 to December 2013 were retrieved from the medical record database in Peking University People’s Hospital to pick up the pathologically confirmed cases of gallbladder adenomyomatosis, and then, the correct diagnostic rate of different imaging examinations, surgical procedures and results were retrospectively analyzed. Results: Among 6 336 patients undergoing gallbladder surgery, 205 cases (3.2%) were pathologically diagnosed as adenomyomatosis of the gallbladder, of whom 195 cases (95.1%) were accompanied with cholecystitis and 150 cases (73.2%) were complicated with gallbladder stones. The correct diagnostic rate of ultrasonography, CT and MRI was 16.2%, 26.5% and 43.8%, respectively. Of the lesions, the localized type accounted for the majority, which was found in 164 cases (80.0%), and the diffuse and segmental types were relatively infrequent, which was seen 16 (7.8%) and 25 cases (12.2%), respectively. Of the patients, 178 cases underwent laparoscopic cholecystectomy and 24 cases were subjected to open cholecystectomy, and no complications such as bile duct injury occurred; 3 cases received partial cholecystectomy. At follow-up one year after operation, no residual lesion or recurrence was noted. Conclusion: Gallbladder adenomyomatosis is often combined with cholecystitis and gallbladder stones, and is likely to be undiagnosed. For cases with localized lesion in the base of the gallbladder, laparoscopic partial cholecystectomy can be considered as a treatment option.

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高鹏骥,张龙辉,王东,陈雷,王福顺,冷希圣,朱继业.胆囊腺肌症的诊治:附205例报告[J].中国普通外科杂志,2015,24(8):1155-1158.
DOI:10.3978/j. issn.1005-6947.2015.08.020

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  • 收稿日期:2015-05-11
  • 最后修改日期:2015-07-05
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  • 在线发布日期: 2015-08-15