Hiraki Masatsugu, Ueda Junji, Kono Hiroshi, Egawa Noriyuki, Saeki Kiyoshi, Tsuru Yasuhiro, Ide Takao, Noshiro Hirokazu
Department of Surgery, Saga University Faculty of Medicine, Saga City, Saga 849-8501, Japan.
J Surg Case Rep. 2017 Nov 7;2017(11):rjx212. doi: 10.1093/jscr/rjx212. eCollection 2017 Nov.
The use of laparoscopic surgery in the treatment of Mirizzi syndrome is considered controversial due to the degree of technical difficulty. We herein describe the case of a 36-year-old woman who was admitted to our hospital due to appetite loss, nausea and back pain. Endoscopic retrograde cholangiography revealed a round-shaped filling defect at the confluence of the bile duct. The patient was diagnosed with Mirizzi syndrome Type II according to the Csendes classification. Before surgery, an endoscopic nasobiliary drainage tube was placed for intraoperative cholangiography. Based on the intraoperative findings, the anterior wall of Hartmann's pouch was excised to remove the impacted gallstone. The neck portion of the gallbladder wall was then used to make a gallbladder patch, which was sutured to cover the anterior wall of the common hepatic bile duct. Laparoscopic choledochoplasty using a gallbladder patch was a technically feasible treatment for Mirizzi syndrome Type II.
由于技术难度，腹腔镜手术在Mirizzi综合征治疗中的应用存在争议。我们在此描述一名36岁女性患者的病例，该患者因食欲减退、恶心和背痛入院。内镜逆行胆管造影显示胆管汇合处有圆形充盈缺损。根据Csendes分类，该患者被诊断为II型Mirizzi综合征。手术前，放置了内镜鼻胆管引流管用于术中胆管造影。根据术中发现，切除Hartmann袋前壁以取出嵌顿的胆结石。然后用胆囊壁的颈部制作胆囊补片，缝合以覆盖肝总管前壁。使用胆囊补片的腹腔镜胆管成形术是治疗II型Mirizzi综合征的一种技术上可行的方法。
