黄色肉芽肿性胆囊炎与胆囊癌的临床特征分析及螺旋CT检查的鉴别诊断价值

目的:研究黄色肉芽肿性胆囊炎(XGC)与胆囊癌的临床特征分析及螺旋CT检查的鉴别诊断价值。方法:选取从2018年1月-2020年12月于我院接受腹部螺旋CT检查的41例XGC患者纳入研究,记作XGC组,另取同期医院接受腹部螺旋CT检查的45例胆囊癌患者作为胆囊癌组。分析两组临床特征、螺旋CT检查结果表现,比较两组血清血管内皮生长因子(VEGF)、糖类抗原19-9(CA19-9)水平的差异。并以病理检查为金标准,分析螺旋CT检查用作XGC与胆囊癌鉴别诊断的价值。结果:XGC组患者食欲下降、体重下降人数占比均低于胆囊癌组(均P<0.05);而两组腹痛、黄疸、发热、白细胞(WBC)升高、谷丙转氨酶(ALT)升高、谷草转氨酶(AST)升高、胆囊扩张发生率对比差异无统计学意义(均P>0.05)。XGC组囊壁增厚均匀、壁内有低密度结节人数占比均低于胆囊癌组,而有肿大淋巴结人数占比高于胆囊癌组(均P<0.05)。螺旋CT检查诊断XGC的灵敏度、特异度、准确度分别为95.12(39/41)、95.56%(43/45)、95.35%(82/86)。XGC组患者血清VEGF、CA19-9水平均低于胆囊癌组,差异均有统计学意义(均P<0.05)。结论:XGC患者食欲下降、体重下降发生率低于胆囊癌患者,螺旋CT检查鉴别诊断XGC与胆囊癌的价值较高,值得临床关注。

The Clinical Characteristics Analysis of Xanthogranulomatous Cholecystitis and Gallbladder Carcinoma and the Value of spiral CT in Differential Diagnosis

ABSTRACT Objective: To study the clinical characteristics analysis of xanthogranulomatous cholecystitis (XGC) and gallbladder carcinoma and the value of spiral CT in differential diagnosis. Methods: A total of 41 patients with XGC who received abdominal spiral CT examination in our hospital from January 2018 to December 2020 were included in the study, and recorded as the XGC group. Another 45 patients with gallbladder cancer who received abdominal spiral CT examination in our hospital during the same period were selected as the gallbladder cancer group. The clinical characteristics and spiral CT results of the two groups were analyzed. The differences of serum vascular endothelial growth factor(VEGF) and carbohydrate antigen 19-9(CA19-9) levels were compared between the two groups. The gold standard was pathological examination, the value of spiral CT in the differential diagnosis of XGC and gallbladder carcinoma was analyzed. Results: The percentages of appetite loss and weight loss in XGC group were lower than those in gallbladder cancer group (all P<0.05). There were no significant differences in the incidence of abdominal pain, jaundice, fever, increased white blood cell (WBC), elevated alanine aminotransferase (ALT), elevated asparate aminotransferase (AST) and bile duct dilatation between the two groups (all P>0.05). The proportion of patients with uniform thickening of cystic wall and low-density nodules in the wall in the XGC group were lower than that in the gallbladder cancer group, while the proportion of patients with enlarged lymph nodes was higher than that in the gallbladder cancer group (all P<0.05). The sensitivity, specificity and accuracy of spiral CT for XGC were 95.12 (39/41), 95.56% (43/45) and 95.35% (82/86), respectively. The levels of serum VEGF and CA19-9 in XGC group were lower than those in gallbladder cancer group, with statistical significance (all P<0.05). Conclusion: The incidence of appetite loss and weight loss in XGC patients are lower than those in gallbladder cancer patients. Spiral CT examination is of high value in the differential diagnosis of XGC and gallbladder cancer, which is worthy of clinical attention.