Department of Gastroenterology and Hepatology, Linkou Medical Center, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan 333, Taiwan.
Department of General Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan 333, Taiwan.
World J Gastroenterol. 2020 Oct 28;26(40):6241-6249. doi: 10.3748/wjg.v26.i40.6241.
Mirizzi syndrome (MS) is defined as an extrinsic compression of the extrahepatic biliary system by an impacted stone in the gallbladder or the cystic duct leading to obstructive jaundice. Endoscopic retrograde cholangiopancreatography (ERCP) could serve diagnostic and therapeutic purposes in patients with MS in addition to revealing the relationships between the cystic duct, the gallbladder, and the common bile duct (CBD). Cholecystectomy is a challenging procedure for a laparoscopic surgeon in patients with MS, and the presence of a cholecystocholedochal fistula renders preoperative diagnosis important during ERCP.
To evaluate cholecystocholedochal fistulas in patients with MS during ERCP before cholecystectomy.
From 2004 to 2018, all patients diagnosed with MS during ERCP were enrolled in this study. Patients with associated malignancy or those who had already undergone cholecystectomy before ERCP were excluded. In total, 117 patients with MS diagnosed by ERCP were enrolled in this study. Among them, 21 patients with MS had cholecystocholedochal fistulas. MS was further confirmed during cholecystectomy to check if cholecystocholedochal fistulas were present. The clinical data, cholangiography, and endoscopic findings during ERCP were recorded and analyzed.
Gallbladder opacification on cholangiography is more frequent in patients with MS complicated by cholecystocholedochal fistulas ( < 0.001). Pus in the CBD and stricture length of the CBD longer than 2 cm were two additional independent factors associated with MS, as demonstrated by multivariate analysis (odds ratio 5.82, = 0.002; 0.12, = 0.008, respectively).
Gall bladder opacification is commonly seen in patients with MS with cholecystocholedochal fistulas during pre-operative ERCP. Additional findings such as pus in the CBD and stricture length of the CBD longer than 2 cm may aid the diagnosis of MS with cholecystocholedochal fistulas.
Mirizzi 综合征（MS）定义为胆囊或胆囊管内嵌顿结石对外科胆管系统的外在压迫，导致阻塞性黄疸。内镜逆行胰胆管造影术（ERCP）除了揭示胆囊管、胆囊和胆总管（CBD）之间的关系外，还可对 MS 患者进行诊断和治疗。对于 MS 患者，腹腔镜胆囊切除术是一种具有挑战性的手术，而胆囊胆管瘘的存在使得 ERCP 术前诊断变得尤为重要。
评估 ERCP 术前 MS 患者的胆囊胆管瘘。
本研究纳入了 2004 年至 2018 年间所有通过 ERCP 诊断为 MS 的患者。排除了伴有恶性肿瘤的患者和那些在 ERCP 之前已经接受过胆囊切除术的患者。本研究共纳入了 117 例通过 ERCP 诊断为 MS 的患者。其中，21 例 MS 患者存在胆囊胆管瘘。在胆囊切除术中进一步证实 MS，以检查是否存在胆囊胆管瘘。记录并分析了 ERCP 期间的临床数据、胆管造影和内镜发现。
胆管造影显示胆囊显影在 MS 合并胆囊胆管瘘患者中更为常见（<0.001）。多元分析显示，CBD 中有脓液和 CBD 狭窄长度大于 2cm 是与 MS 相关的另外两个独立因素（优势比 5.82， = 0.002；0.12， = 0.008）。
术前 ERCP 中，MS 合并胆囊胆管瘘患者胆囊显影更为常见。CBD 中有脓液和 CBD 狭窄长度大于 2cm 等附加发现可能有助于 MS 合并胆囊胆管瘘的诊断。
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