Nitta Toshikatsu, Chino Yoshihide, Kataoka Jun, Ohta Masahito, Tominaga Tomo, Fujii Kensuke, Ishibashi Takashi
Division of Surgery, Gastroenterological Center, Medico Shunju Shiroyama Hospital, Osaka, Japan.
Department of Surgery, Laparoscopic Surgery Center, Daiichi Towakai Hospital, Osaka, Japan.
Asian J Endosc Surg. 2019 Apr;12(2):227-231. doi: 10.1111/ases.12602. Epub 2018 Dec 13.
A 50-year-old Japanese man presented with obstructive jaundice. We performed endoscopic retrograde biliary drainage before biliary decompression. CT showed a thickened gallbladder wall with low-density areas and a 35-mm gallstone; the stone was impacted in the gallbladder neck and cystic duct. The patient was therefore diagnosed with Mirizzi syndrome (type II or III) and scheduled for laparoscopic treatment. We performed subtotal cholecystectomy and intraoperative choledochoscopy because we recognized a fistula between the gallbladder and common bile duct preoperatively.
We opened the ductus choledochus, and a choledochoscope was introduced under laparoscopic guidance. An electrohydraulic lithotripsy probe with irrigation was passed through the choledochoscope to extract the gallstone.
This fragmentation technique is effective for impacted large stones observed in Mirizzi syndrome. Therefore, electrohydraulic lithotripsy with laparoscopy is effective in cases of difficult gallbladder access such as that that occurs in type II or III Mirizzi syndrome.
一名50岁的日本男性出现梗阻性黄疸。在进行胆道减压之前，我们先进行了内镜逆行胆道引流。CT显示胆囊壁增厚，有低密度区，还有一枚35毫米的胆结石；结石嵌顿在胆囊颈部和胆囊管。因此，该患者被诊断为Mirizzi综合征（II型或III型），并计划进行腹腔镜治疗。由于术前发现胆囊与胆总管之间存在瘘管，我们实施了胆囊次全切除术并进行了术中胆管镜检查。
我们切开胆总管，在腹腔镜引导下插入胆管镜。将带有冲洗功能的电液压碎石探头通过胆管镜插入以取出胆结石。
这种碎石技术对于Mirizzi综合征中观察到的嵌顿大结石有效。因此，腹腔镜下的电液压碎石术对于II型或III型Mirizzi综合征中出现的胆囊难以进入的情况有效。
