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腹腔镜下Mirizzi综合征胆囊次全切除术:1例报告

Laparoscopic subtotal cholecystectomy for Mirizzi syndrome: A report of a case.

作者信息

Kimura Jiro, Takata Naokazu, Lefor Alan Kawarai, Kanzaki Masaki, Mizokami Ken

机构信息

Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan.

Department of Surgery, Jichi Medical University, Tochigi, Japan.

出版信息

Int J Surg Case Rep. 2019;55:32-34. doi: 10.1016/j.ijscr.2019.01.010. Epub 2019 Jan 19.

Abstract

INTRODUCTION

Mirizzi syndrome is a rare complication of gallstone disease. The purpose of this report is to describe the utility of laparoscopic subtotal cholecystectomy for Mirizzi syndrome.

PRESENTATION OF CASE

A 53-year-old female presented with dark urine and right upper quadrant pain. Blood tests revealed elevated liver and biliary enzyme levels. Magnetic resonance cholangiopancreatography showed a narrowed common hepatic duct compressed by a large gallstone, consistent with Mirizzi syndrome. Semi-urgent laparoscopic cholecystectomy was planned. At operation, circumferential dissection of the gallbladder neck was difficult. The fundus of the gallbladder was opened and a 2 cm stone extracted. The gallbladder neck was sutured and a drain placed. The postoperative clinical course was uneventful.

DISCUSSION

After laparoscopic cholecystectomy in patients with Mirizzi syndrome, complication rates, including bile duct injuries, is high. In patients with Mirizzi syndrome, removal of the responsible stone is the main purpose of treatment.

CONCLUSION

Laparoscopic subtotal cholecystectomy is a useful technique for patients with Mirizzi syndrome to avoid bile duct injury.

摘要

引言

Mirizzi综合征是胆石症的一种罕见并发症。本报告的目的是描述腹腔镜胆囊次全切除术治疗Mirizzi综合征的效用。

病例介绍

一名53岁女性出现尿色加深和右上腹疼痛。血液检查显示肝酶和胆酶水平升高。磁共振胰胆管造影显示肝总管被一枚大结石压迫变窄,符合Mirizzi综合征。计划进行半急诊腹腔镜胆囊切除术。手术中,胆囊颈部的环形分离困难。打开胆囊底部,取出一枚2厘米的结石。缝合胆囊颈部并放置引流管。术后临床过程顺利。

讨论

Mirizzi综合征患者行腹腔镜胆囊切除术后,包括胆管损伤在内的并发症发生率较高。对于Mirizzi综合征患者,取出责任结石是主要治疗目的。

结论

腹腔镜胆囊次全切除术是一种对Mirizzi综合征患者有用的技术,可避免胆管损伤。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f247/6351350/390b3bc11926/gr1.jpg

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