Yip A W, Chow W C, Chan J, Lam K H
Department of Surgery, University of Hong Kong, Kwong Wah Hospital.
Surgery. 1992 Mar;111(3):335-8.
Gallstone obstruction of the cystic duct with resulting repeated attacks of inflammation and pressure necrosis leads to the formation of cholecystocholedochal fistulas (Mirizzi syndrome type II). Obstructive jaundice and cholangitis are the common presentations of the condition. These fistulas are often not recognized before operation and constitute a high risk of damage to the common duct during a formal cholecystectomy. A high index of suspicion is required to diagnose the condition. We report five patients with cholecystocholedochal fistulas diagnosed by endoscopic retrograde cholangiography that delineated the fistula and the obstructing stone. The plan of management was formulated before surgery, and persistent attempt to dissect the Calot's triangle was avoided. In three patients the common duct defect was closed with the use of a gallbladder flap. Hepaticojejunostomy was required for the two difficult cases with large common duct defects and inflamed tissue.
胆囊管结石梗阻导致反复炎症发作和压迫性坏死，进而形成胆囊胆总管瘘（Mirizzi综合征II型）。梗阻性黄疸和胆管炎是该病症的常见表现。这些瘘管在手术前常未被识别，在进行正规胆囊切除术时，存在损伤胆总管的高风险。诊断该病症需要高度的怀疑指数。我们报告了5例经内镜逆行胆管造影诊断为胆囊胆总管瘘的患者，该检查明确了瘘管和阻塞结石。在手术前制定了治疗方案，避免了持续尝试解剖胆囊三角。3例患者使用胆囊瓣关闭胆总管缺损。对于2例胆总管缺损大且组织发炎的困难病例，需要进行肝空肠吻合术。
