[一名疑似患有Mirizzi综合征的患者]

[A patient with a possible Mirizzi's syndrome].

作者信息

Niebling Maarten G, Schattenkerk Marinus Eeftinck, Liem Mike S L

机构信息

Deventer Ziekenhuis, afd. Heelkunde, Deventer, the Netherlands.

出版信息

Ned Tijdschr Geneeskd. 2011;155(18):A3528.

PMID:21771366

Abstract

BACKGROUND

Mirizzi's syndrome is a rare cause of jaundice. The syndrome refers to common hepatic duct obstruction or choledoch duct obstruction caused by extrinsic compression of an impacted stone in the gallbladder neck or cystic duct.

CASE DESCRIPTION

A 42-year-old woman was referred to the emergency department with symptoms indicative of obstructive icterus. Endoscopic retrograde cholangiopancreatography (ERCP) and a CT scan revealed signs of Mirizzi's syndrome but no indications of malignancy. Laparoscopic cholecystectomy was decided upon. This procedure revealed that the obstruction was caused by a gallbladder carcinoma.

CONCLUSION

Of those patients suspected of having Mirizzi's syndrome, retrospectively 5-28% prove to have carcinoma of the gallbladder. Therefore in Mirizzi's syndrome before carrying out laparoscopic cholecystectomy a careful diagnostic approach is essential. This includes ERCP or MRI cholangiopancreaticography (MRCP) and a CT scan. Even after these investigations the surgeon should only perform laparoscopic surgery with caution, as it is often converted to an open procedure and because of the risk of presence of a malignancy.

摘要

背景

Mirizzi综合征是导致黄疸的罕见原因。该综合征是指因胆囊颈部或胆囊管内嵌顿结石的外在压迫引起的肝总管梗阻或胆总管梗阻。

病例描述

一名42岁女性因出现梗阻性黄疸症状被转诊至急诊科。内镜逆行胰胆管造影（ERCP）和CT扫描显示有Mirizzi综合征的迹象，但无恶性肿瘤指征。决定行腹腔镜胆囊切除术。该手术显示梗阻是由胆囊癌引起的。

结论

在疑似患有Mirizzi综合征的患者中，回顾性研究表明5% - 28%的患者患有胆囊癌。因此，在Mirizzi综合征患者进行腹腔镜胆囊切除术之前，谨慎的诊断方法至关重要。这包括ERCP或磁共振胰胆管造影（MRCP）以及CT扫描。即使经过这些检查，外科医生进行腹腔镜手术时也应谨慎，因为手术往往会转为开放手术，且存在恶性肿瘤的风险。