Karaahmet Fatih, Kekilli Murat
Department of Gastroenterology, Atilim University Medical School.
Department of Gastroenterology, Gazi University Medical School, Ankara, Turkey.
Eur J Gastroenterol Hepatol. 2023 May 1;35(5):537-540. doi: 10.1097/MEG.0000000000002534. Epub 2023 Feb 25.
Mirizzi syndrome is a gallstone disease characterized by compression of extrahepatic biliary duct with an impacted stone. Our aim is to identify and describe the incidence, clinical presentation, operative details and the association postoperative complication of Mirizzi syndrome in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP).
The ERCP procedures were held in Gastroenterology Endoscopy Unit and retrospectively evaluated. The patients were divided into two groups, the cholelithiasis + common bile duct (CBD) stone group and the Mirizzi syndrome group. These groups were compared with the demographic characteristics, ERCP procedures, types of Mirizzi syndrome and surgical technique.
A total of 1018 consecutive patients who underwent ERCP were scanned retrospectively. Of the 515 patients fulfilling the criteria for ERCP, 12 had Mirizzi syndrome and 503 had cholelithiasis and CBD stones. Half of the Mirizzi syndrome patients were diagnosed with pre-ERCP ultrasonography. The mean diameter of choledoc was found to be 10 mm in ERCP. ERCP-related complication rates (pancreatitis, bleeding and perforation) were the same in the two groups; 66.6% of the Mirizzi syndrome patients applied cholecystectomy and placement of T-tube surgical procedures, and there were no postoperative complications.
Surgery is the definitive treatment of Mirizzi syndrome. Thus patients should have a correct preoperative diagnosis for an appropriate and safe surgery. We think that ERCP could be the best guide for this. Also, we believe that intraoperative cholangiography with ERCP and hybrid procedures for guiding surgical treatment may become an advanced treatment option in the future.
Mirizzi综合征是一种以结石嵌顿导致肝外胆管受压为特征的胆结石疾病。我们的目的是确定并描述接受内镜逆行胰胆管造影术（ERCP）的患者中Mirizzi综合征的发病率、临床表现、手术细节及术后并发症的相关性。
在胃肠病学内镜科进行ERCP手术，并进行回顾性评估。将患者分为两组，即胆石症+胆总管（CBD）结石组和Mirizzi综合征组。对这两组患者的人口统计学特征、ERCP手术、Mirizzi综合征类型及手术技术进行比较。
对1018例连续接受ERCP的患者进行回顾性扫描。在符合ERCP标准的515例患者中，12例患有Mirizzi综合征，503例患有胆石症和CBD结石。一半的Mirizzi综合征患者在ERCP前通过超声检查确诊。在ERCP中发现胆总管的平均直径为10毫米。两组的ERCP相关并发症发生率（胰腺炎、出血和穿孔）相同；66.6%的Mirizzi综合征患者接受了胆囊切除术和T管置入手术，且无术后并发症。
手术是Mirizzi综合征的确定性治疗方法。因此，患者应进行正确的术前诊断，以进行适当且安全的手术。我们认为ERCP可能是实现这一目标的最佳指导。此外，我们相信术中ERCP胆管造影及用于指导手术治疗的混合手术可能会成为未来的一种先进治疗选择。
