Moon Jong Ho, Cho Young Deok, Cheon Young Koog, Ryu Chang Beom, Kim Young Seok, Kim Jin Oh, Cho Joo Young, Kim Yun Soo, Lee Joon Seong, Lee Moon Sung, Shim Chan Sup, Kim Boo Sung
Institute for Digestive Research, Digestive Disease Center, Soon Chun Hyang University College of Medicine, Seoul, Korea.
Gastrointest Endosc. 2002 Dec;56(6):873-9. doi: 10.1067/mge.2002.129957.
Mirizzi syndrome refers to common hepatic duct obstruction caused by extrinsic compression that is usually from a stone impacted in the cystic duct. The utility of transpapillary intraductal US for assessment of biliary strictures with radiographic features of Mirizzi syndrome was studied retrospectively.
Intraductal US was performed in 16 patients with a common hepatic duct stricture caused by extrinsic compression and nonvisualization of the gallbladder by endoscopic retrograde cholangiography. An over-the-wire catheter US probe (20 MHz) was inserted into the bile duct. Intraductal US findings were compared with the final diagnoses at surgery.
Intraductal US was successful in all patients. The extraluminal cause of the common hepatic duct stricture was detected in 14 patients (87.5%). In 9 patients, intraductal US detected an impacted stone outside the common hepatic duct. Intraductal US demonstrated extraluminal lesions without evidence of a stone in 5 patients, including a mass in 4 and asymmetrical, irregular thickening of the bile duct wall in 1 patient. In the remaining 2 patients, intraductal US demonstrated only a distended gallbladder.
Transpapillary wire-guided intraductal US is useful for assessing biliary strictures with features that suggest Mirizzi syndrome and optimizes management of patients with these findings.
Mirizzi综合征是指由外部压迫导致的肝总管梗阻，通常是由于胆囊管内结石嵌顿所致。回顾性研究了经乳头胆管内超声检查在评估具有Mirizzi综合征影像学特征的胆管狭窄中的应用。
对16例因外部压迫导致肝总管狭窄且经内镜逆行胆管造影未显示胆囊的患者进行了胆管内超声检查。将带导丝导管超声探头（20MHz）插入胆管。将胆管内超声检查结果与手术最终诊断结果进行比较。
所有患者的胆管内超声检查均成功。14例患者（87.5%）检测到肝总管狭窄的管腔外原因。9例患者中，胆管内超声检查在肝总管外检测到嵌顿结石。5例患者胆管内超声检查显示管腔外病变但无结石证据，其中4例为肿块，1例为胆管壁不对称、不规则增厚。其余2例患者胆管内超声检查仅显示胆囊扩张。
经乳头导丝引导的胆管内超声检查有助于评估具有提示Mirizzi综合征特征的胆管狭窄，并优化对有这些表现患者的管理。
