Chan C Y, Liau K H, Ho C K, Chew S P
Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433.
Surgeon. 2003 Oct;1(5):273-8. doi: 10.1016/s1479-666x(03)80044-6.
Mirizzi syndrome (MS) is an unusual complication of gallstone disease. The majority of cases are not identified pre-operatively, despite advances in imaging techniques.
Eighteen cases of MS were treated between January 1997 and April 2002. The clinical presentation, modes of investigation, surgical management and outcome are retrospectively reviewed.
There were 13 female and 5 male patients, with a mean age of 60 years. Seven patients presented with the classical Charcot's triad. Ultrasonography (US) was the first imaging investigation in 13 patients and computerised tomography (CT) in the other five cases. Eleven patients had a successful endoscopic retrograde cholangio-pancreatography (ERCP) carried out. Diagnosis of MS was arrived at in seven patients following pre-operative imagings. Overall, 11 patients had Type 1 and seven patients had Type 2 MS. In the group with Type 1 MS, nine patients underwent open cholecystectomy, of whom six had concomitant common bile duct (CBD) exploration for stones and one patient with biliary stenosis had a hepaticojejunostomy bypass. Laparoscopic cholecystectomy was attempted in two patients, with successful completion in one case. In the group with Type 2 MS, four fistulas were closed surgically, the other three had biliary bypass procedures.
Mirizzi syndrome is an unusual condition that poses diagnostic and operative challenges to the surgeon. With a judicious approach during dissection and early recognition of its presence, bile duct injury can be avoided. Good outcome can be achieved with an appropriate surgical procedure.
Mirizzi综合征（MS）是胆结石疾病的一种罕见并发症。尽管成像技术有所进步，但大多数病例在术前仍未被识别。
回顾性分析1997年1月至2002年4月间治疗的18例MS患者的临床表现、检查方式、手术治疗及结果。
患者中女性13例，男性5例，平均年龄60岁。7例患者出现典型的夏科氏三联征。13例患者首先进行超声检查（US），另外5例进行计算机断层扫描（CT）。11例患者成功进行了内镜逆行胰胆管造影（ERCP）。7例患者经术前影像学检查后确诊为MS。总体而言，11例患者为1型MS，7例患者为2型MS。在1型MS组中，9例患者接受了开腹胆囊切除术，其中6例同时进行了胆总管（CBD）结石探查，1例胆管狭窄患者进行了肝空肠吻合术搭桥。2例患者尝试进行腹腔镜胆囊切除术，1例成功完成。在2型MS组中，4例瘘管通过手术闭合，另外3例进行了胆肠吻合术。
Mirizzi综合征是一种罕见疾病，对外科医生提出了诊断和手术挑战。在手术解剖过程中采取明智的方法并早期识别该疾病，可避免胆管损伤。采用适当的手术方法可取得良好的治疗效果。
