Tsuyuguchi T, Saisho H, Ishihara T, Yamaguchi T, Onuma E K
First Department of Medicine and the Department of Endoscopic Diagnostics and Therapeutics, Chiba University School of Medicine, Chiba, Japan.
Gastrointest Endosc. 2000 Nov;52(5):639-44. doi: 10.1067/mge.2000.108971.
The standard treatment for Mirizzi syndrome is surgical, although endoscopic and percutaneous management have also been described. The aim of this study was to evaluate the usefulness of shock wave lithotripsy combined with peroral cholangioscopy and its long-term outcome in patients with Mirizzi syndrome.
The records of 25 patients with Mirizzi syndrome who underwent endoscopic treatment between April 1990 and November 1998 were retrospectively reviewed. Shock wave lithotripsy was performed under direct vision with a "mother-baby" endoscope system in 2 patients with type I and 23 with type II Mirizzi syndrome (12 men and 13 women, mean age 60 years). Follow-up data were obtained from clinical records or through telephone interviews.
In the two patients with type I, the cholangioscopic approach failed and both patients underwent open cholecystectomy. The 23 patients with type II were all successfully treated with shock wave lithotripsy alone. The cholangioscopic approach was unsuccessful in the treatment of residual gallbladder stones. Follow-up data were obtained in all but one patient (mean 43.6 months, range 4 to 103 months). Of the 23 patients with type II, 12 with no gallbladder stones had remained asymptomatic during the follow-up period. Of the 6 patients with type II with large residual gallbladder stones, 4 had acute cholangitis due to stone migration 6, 9, 28, and 34 months after endoscopic treatment. Two patients died during the follow-up period, one of non-biliary causes and the other of coexistent gallbladder carcinoma.
Endoscopic treatment of Mirizzi syndrome using peroral cholangioscopy is a safe and effective alternative to surgery, especially in patients with the type II syndrome. A favorable long-term outcome depends on the absence of large residual gallbladder stones.
尽管也有内镜及经皮治疗的报道，但Mirizzi综合征的标准治疗方法是手术治疗。本研究旨在评估冲击波碎石术联合经口胆管镜检查在Mirizzi综合征患者中的有效性及其长期疗效。
回顾性分析1990年4月至1998年11月间接受内镜治疗的25例Mirizzi综合征患者的病历。2例Ⅰ型和23例Ⅱ型Mirizzi综合征患者（12例男性，13例女性，平均年龄60岁）在“母子”内镜系统直视下进行冲击波碎石术。随访数据来自临床记录或电话访谈。
2例Ⅰ型患者胆管镜检查方法失败，均接受了开腹胆囊切除术。23例Ⅱ型患者均单独采用冲击波碎石术成功治疗。胆管镜检查方法治疗残余胆囊结石未成功。除1例患者外，所有患者均获得随访数据（平均43.6个月，范围4至103个月）。23例Ⅱ型患者中，12例无胆囊结石者在随访期间无症状。6例有大量残余胆囊结石的Ⅱ型患者中，4例在内镜治疗后6、9、28和34个月因结石移位发生急性胆管炎。2例患者在随访期间死亡，1例死于非胆道原因，另1例死于并存的胆囊癌。
采用经口胆管镜检查对Mirizzi综合征进行内镜治疗是一种安全有效的手术替代方法，尤其是对Ⅱ型综合征患者。良好的长期疗效取决于无大量残余胆囊结石。
