Khalid Sadaf, Bhatti Afsar Ali
J Ayub Med Coll Abbottabad. 2014 Oct-Dec;26(4):621-4.
The Mirizzi's syndrome is a rarely observed disorder that refers to common hepatic duct obstruction caused by an extrinsic compression from an impacted stone in the cystic duct or Hartmann's pouch of the gallbladder. It has been estimated to occur in 0.7-1.8 percent of all cholecystectomies. The preoperative diagnosis of Mirrizi's syndrome is a not always easy despite the availability of latest advances in the radiological tests which can lead to significant morbidity and bile duct injury. We present the case of a 50-year-old Asian female with Mirizzi's syndrome who was initially having an impression of cholangiocarcinoma with cholecystitis and cholelithiasis based on radiological findings. Our patient was diagnosed as having Mirizzi's syndrome on an IV contrast CT scan. Cholecystectomy was performed with a restoration of biliary drainage by placing a t-tube. The on- table findings of the Mirizzi's syndrome can vary considerably as compared to the preliminary diagnosis based upon the biochemical tests and the radiological studies. The grade of the fistula, the extent of involvement of the biliary channels can only be found out on proper on-table surgical assessment.
Mirizzi综合征是一种罕见的疾病，指胆囊管或胆囊Hartmann袋内嵌顿结石的外在压迫导致肝总管梗阻。据估计，它在所有胆囊切除术中的发生率为0.7%-1.8%。尽管放射学检查有最新进展，但Mirizzi综合征的术前诊断并不总是容易，这可能导致严重的发病率和胆管损伤。我们报告一例50岁亚洲女性Mirizzi综合征病例，根据放射学检查结果，最初诊断为胆管癌合并胆囊炎和胆结石。我们的患者通过静脉造影CT扫描被诊断为Mirizzi综合征。通过放置T管进行胆囊切除术并恢复胆汁引流。与基于生化检查和放射学研究的初步诊断相比，Mirizzi综合征的术中表现可能有很大差异。瘘管的分级、胆管受累的程度只能通过适当的术中手术评估来确定。
