Shirah Bader Hamza, Shirah Hamza Asaad, Albeladi Khalid B
King Abdullah International Medical Research Center / King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
Department of General Surgery, Al Ansar General Hospital, Medina, Saudi Arabia.
Ann Hepatobiliary Pancreat Surg. 2017 Aug;21(3):122-130. doi: 10.14701/ahbps.2017.21.3.122. Epub 2017 Aug 31.
BACKGROUNDS/AIMS: The challenging dilemma of Mirizzi syndrome for operating surgeons arises from the difficulty to diagnose it preoperatively, and approximately 50% of cases are diagnosed intraoperatively. In this study, we analysed the effectiveness of diagnostic modalities and treatment options in our series of Mirizzi syndrome.
Patients had a preoperative or intraoperative diagnosis of Mirizzi syndrome, and were classified into three groups: Group 1: Incidental finding of Mirizzi syndrome intraoperatively (n=34). Group 2: Patients presented with jaundice, diagnosed by endoscopic retrograde cholangiopancreatography (n=17). Group 3: Patients diagnosed initially by ultrasound (n=13). Laparoscopic cholecystectomy was conducted in all 49 patients with Cendes type I disease. Partial cholecystectomy, common bile duct exploration, repair of fistula and t-tube placement was conducted on eight patients with Cendes type II and five patients with Cendes type III. Partial cholecystectomy with Roux-en-Y hepaticojejunostomy was conducted in two patients with Cendes type IV disease.
Sixty-four patients were diagnosed with Mirizzi syndrome. Morbidity rate was 3.1%. Mortality rate was 0%. Group 3 (patients diagnosed initially by ultrasound) had the best treatment outcome, the least morbidity, and the shortest hospital stay.
Suspected cases of Mirizzi syndrome should not be underestimated. Difficulty in establishing preoperative diagnosis is the major dilemma. As it is mostly encountered intraoperatively, the approach should be careful and logical to identify the correct type of Mirizzi by a thorough diagnostic laparoscopy and thus, provide optimum treatment for the subtype to achieve the best outcome.
背景/目的：对于外科手术医生而言，米里齐综合征极具挑战性的难题在于术前诊断困难，约50%的病例是在术中确诊的。在本研究中，我们分析了一系列米里齐综合征病例中诊断方法和治疗方案的有效性。
患者术前或术中被诊断为米里齐综合征，并分为三组：第1组：术中偶然发现米里齐综合征（n = 34）。第2组：出现黄疸的患者，通过内镜逆行胰胆管造影确诊（n = 17）。第3组：最初通过超声诊断的患者（n = 13）。所有49例Cendes I型疾病患者均行腹腔镜胆囊切除术。8例Cendes II型和5例Cendes III型患者行部分胆囊切除术、胆总管探查、瘘管修复及T管置入。2例Cendes IV型疾病患者行部分胆囊切除术加Roux-en-Y肝空肠吻合术。
64例患者被诊断为米里齐综合征。发病率为3.1%。死亡率为0%。第3组（最初通过超声诊断的患者）治疗效果最佳，发病率最低，住院时间最短。
疑似米里齐综合征的病例不应被低估。术前诊断困难是主要难题。由于该病大多在术中遇到，手术方法应谨慎且合理，通过全面的诊断性腹腔镜检查确定正确的米里齐类型，从而为亚型提供最佳治疗以取得最佳效果。
