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Abstract：
OBJECTIVE: Xanthogranulomatous cholecystitis (XGC) is a rare variant of chronic cholecystitis. This rare pathology is characterized by severe and progressive fibrosis of the gallbladder wall as well as infiltration of fat-laden macrophages.
METHODS: The final pathology report of 8213 cholecystectomies performed between 2011 and 2019 was evaluated retrospectively, and patients whose pathology result was reported as XGC were included in the study. Patients\' demographic characteristics, pathology results, and surgical methods were evaluated. Logistic regression analysis was performed for risk factors on conversion to open cholecystectomy.
RESULTS: The rate of XGC among cholecystectomies was 0.91%. Mean age of the patients was 57.32 years. Laparoscopic cholecystectomy was applied to 92% (n: 69) of the patients. None of the patients had cancer suspicion in the preoperative period, but cancer suspicion was found in 10.6% of the patients during the operation. With the frozen test, unnecessary surgeries were prevented in these patients. Conversion rate to open cholecystectomy was found to be 26.09%. The most common reason for conversion to open cholecystectomy (66.7%) was intense fibrosis. Increased gallbladder wall thickness and acute cholecystitis were found to be statistically significant risk factors in ultrasonography (p <0.05). Total complication rate in XGC cases was 3.9%.
CONCLUSIONS: XGC is an extremely rare disease and is difficult to diagnose before cholecystectomy. Especially in preoperative USG, in cases with no suspicion of malignancy, but with suspected malignancy during the operation, histopathological examination with frozen method before extensive surgery may prevent unnecessary dissection and related morbidities.
METHODS: The final pathology report of 8213 cholecystectomies performed between 2011 and 2019 was evaluated retrospectively, and patients whose pathology result was reported as XGC were included in the study. Patients\' demographic characteristics, pathology results, and surgical methods were evaluated. Logistic regression analysis was performed for risk factors on conversion to open cholecystectomy.
RESULTS: The rate of XGC among cholecystectomies was 0.91%. Mean age of the patients was 57.32 years. Laparoscopic cholecystectomy was applied to 92% (n: 69) of the patients. None of the patients had cancer suspicion in the preoperative period, but cancer suspicion was found in 10.6% of the patients during the operation. With the frozen test, unnecessary surgeries were prevented in these patients. Conversion rate to open cholecystectomy was found to be 26.09%. The most common reason for conversion to open cholecystectomy (66.7%) was intense fibrosis. Increased gallbladder wall thickness and acute cholecystitis were found to be statistically significant risk factors in ultrasonography (p <0.05). Total complication rate in XGC cases was 3.9%.
CONCLUSIONS: XGC is an extremely rare disease and is difficult to diagnose before cholecystectomy. Especially in preoperative USG, in cases with no suspicion of malignancy, but with suspected malignancy during the operation, histopathological examination with frozen method before extensive surgery may prevent unnecessary dissection and related morbidities.
摘要：
目的：黄色肉芽肿性胆囊炎（XGC）是慢性胆囊炎的一种罕见变种。这种罕见的病理特征是胆囊壁严重和进行性纤维化以及富含脂肪的巨噬细胞浸润。
方法：回顾性分析2011-2019年8213例胆囊切除术的最终病理报告，将病理结果报告为XGC的患者纳入研究。患者的人口统计学特征，病理结果,并对手术方法进行了评价。对中转开腹胆囊切除术的危险因素进行Logistic回归分析。
结果：胆囊切除术中XGC的发生率为0.91%。患者的平均年龄为57.32岁。92％（n：69）的患者采用了腹腔镜胆囊切除术。这些患者在术前都没有怀疑癌症，但是在手术中发现10.6％的患者怀疑癌症。有了冷冻测试，这些患者避免了不必要的手术。开腹胆囊切除术的转化率为26.09%。转换为开腹胆囊切除术的最常见原因（66.7％）是强烈的纤维化。超声检查发现胆囊壁厚度增加和急性胆囊炎是有统计学意义的危险因素（p<0.05）。XGC病例的总并发症发生率为3.9%。
结论：XGC是一种极其罕见的疾病，在胆囊切除术前难以诊断。特别是在术前USG中，在没有怀疑恶性肿瘤的情况下，但手术期间怀疑是恶性肿瘤,在大范围手术前使用冷冻方法进行组织病理学检查可以防止不必要的解剖和相关的并发症。
方法：回顾性分析2011-2019年8213例胆囊切除术的最终病理报告，将病理结果报告为XGC的患者纳入研究。患者的人口统计学特征，病理结果,并对手术方法进行了评价。对中转开腹胆囊切除术的危险因素进行Logistic回归分析。
结果：胆囊切除术中XGC的发生率为0.91%。患者的平均年龄为57.32岁。92％（n：69）的患者采用了腹腔镜胆囊切除术。这些患者在术前都没有怀疑癌症，但是在手术中发现10.6％的患者怀疑癌症。有了冷冻测试，这些患者避免了不必要的手术。开腹胆囊切除术的转化率为26.09%。转换为开腹胆囊切除术的最常见原因（66.7％）是强烈的纤维化。超声检查发现胆囊壁厚度增加和急性胆囊炎是有统计学意义的危险因素（p<0.05）。XGC病例的总并发症发生率为3.9%。
结论：XGC是一种极其罕见的疾病，在胆囊切除术前难以诊断。特别是在术前USG中，在没有怀疑恶性肿瘤的情况下，但手术期间怀疑是恶性肿瘤,在大范围手术前使用冷冻方法进行组织病理学检查可以防止不必要的解剖和相关的并发症。
