Sato Hirofumi, Hiraki Masatsugu, Miyoshi Atsushi, Ikeda Shota, Koga Hiroki, Kitahara Kenji
Department of Surgery, Saga Medical Centre Koseikan, 400 Nakabaru, Kasemachi, Saga City, Saga, 849-8571, Japan.
Department of Surgery, Saga Medical Centre Koseikan, 400 Nakabaru, Kasemachi, Saga City, Saga, 849-8571, Japan.
Int J Surg Case Rep. 2020;77:673-676. doi: 10.1016/j.ijscr.2020.11.106. Epub 2020 Nov 21.
Mirizzi syndrome is an unusual condition involving gallstones. Laparotomy is recommended for the treatment of Mirizzi syndrome type II due to the risk of biliary duct injury. We herein report tips for performing laparoscopic surgery for Mirizzi syndrome type II as a treatment option.
A 72-year-old woman was admitted to our hospital due to abdominal pain and a fever. The diagnosis of Mirrizi syndrome type II was made. Therefore, an endoscopic retrograde biliary drainage tube was placed, and laparoscopic surgery was performed. During the operation, the gallbladder wall was excised at the Hartmann's pouch, and a gallstone was extracted. A fistula between the gallbladder and bile duct was confirmed, and the diagnosis of Mirizzi syndrome type II was made. Partial resection of the gallbladder was performed, and the neck of the gallbladder was sutured. The postoperative course was uneventful.
The preoperative diagnosis is important for Mirizzi syndrome, and the combination of various modalities, including endoscopic retrograde cholangiopancreatography, can increase the diagnostic rate. It is often difficult to recognize the anatomy during surgery for Mirizzi syndrome due to severe inflammation. Therefore, it is best to dissect the gallbladder from the bottom, perform excision at the Hartmann's pouch, remove the gallstone and suture the gallbladder wall. Replacement of the biliary tube can aid in recognizing the anatomy and bile duct.
Laparoscopic surgery for Mirizzi syndrome is a viable treatment option following an accurate preoperative diagnosis and the recognition of the anatomy during the operation.
Mirizzi综合征是一种涉及胆结石的罕见病症。由于存在胆管损伤风险，推荐开腹手术治疗II型Mirizzi综合征。我们在此报告将腹腔镜手术作为II型Mirizzi综合征治疗选择的操作要点。
一名72岁女性因腹痛和发热入院。诊断为II型Mirrizi综合征。因此，放置了内镜逆行胆管引流管，并进行了腹腔镜手术。手术过程中，在Hartmann袋处切除胆囊壁，取出胆结石。确认胆囊与胆管之间存在瘘管，诊断为II型Mirizzi综合征。进行了胆囊部分切除术，并缝合了胆囊颈部。术后病程顺利。
术前诊断对Mirizzi综合征很重要，包括内镜逆行胰胆管造影在内的多种检查方式联合使用可提高诊断率。由于炎症严重，Mirizzi综合征手术中常难以辨认解剖结构。因此，最好从胆囊底部开始分离，在Hartmann袋处进行切除，取出胆结石并缝合胆囊壁。更换胆管有助于辨认解剖结构和胆管。
在准确的术前诊断和术中辨认解剖结构后，腹腔镜手术治疗Mirizzi综合征是一种可行的治疗选择。
