Quang Pham Vinh, Lai Vo Thien, Cuong Dam Chi, Duc Nguyen Minh
Department of Hepatobiliary and Pancreatic Surgery, Binh Dan Hospital, Ho Chi Minh City, Vietnam.
Department of Radiology, Binh Dan Hospital, Ho Chi Minh City, Vietnam.
Radiol Case Rep. 2023 May 29;18(8):2667-2672. doi: 10.1016/j.radcr.2023.05.014. eCollection 2023 Aug.
Mirizzi syndrome is a rare chronic cholecystitis complication. However, the current consensus on managing this condition remains controversial, especially through laparoscopic surgery. This report describes the feasibility of treating type I Mirizzi syndrome with laparoscopic subtotal cholecystectomy and electrohydraulic lithotripsic gallstone removal. A 53-year-old woman presented with dark urine and right upper quadrant pain for 1 month. On examination, she was jaundiced. Blood tests showed highly elevated liver and biliary enzyme levels. Abdominal ultrasound showed a slightly dilated common bile duct with suspicion of choledocholithiasis. However, endoscopic retrograde cholangiopancreatography showed a narrowed common bile duct extrinsically compressed by a gallstone in the cystic duct, establishing a Mirizzi syndrome diagnosis. Elective laparoscopic cholecystectomy was planned. At operation, the trans-infundibulum approach was used since dissection around the cystic duct was difficult due to severe local inflammation of Calot's triangle. The gallbladder's neck was opened, and the stone was removed by lithotripsy via a flexible choledochoscope. Common bile duct exploration through the cystic duct was normal. The fundus and body of the gallbladder were resected, followed by T-tube drainage and suturing of the gallbladder's neck. The patient's postoperative clinical course was uneventful. Treating Mirizzi syndrome remains a major challenge for hepatobiliary specialists even with open surgery due to high complication rates, including bile duct injuries. Treatment is primarily to clear out the responsible stone and necrotic tissue. Due to advances in endoscopic surgery and equipment, subtotal cholecystectomy with laparoscopic gallstone extraction provides a safe and effective option for patients with Mirizzi syndrome. Laparoscopic subtotal cholecystectomy with electrohydraulic lithotripsy is a feasible and useful approach for treating Mirizzi syndrome that avoids iatrogenic bile duct injury.
Mirizzi综合征是一种罕见的慢性胆囊炎并发症。然而，目前对于该病症的治疗共识仍存在争议，尤其是通过腹腔镜手术治疗时。本报告描述了采用腹腔镜次全胆囊切除术及电液压碎石取石术治疗Ⅰ型Mirizzi综合征的可行性。一名53岁女性因尿色深及右上腹疼痛1个月前来就诊。检查发现她有黄疸。血液检查显示肝酶和胆酶水平显著升高。腹部超声显示胆总管轻度扩张，怀疑有胆总管结石。然而，内镜逆行胰胆管造影显示胆总管因胆囊管内结石而受到外在压迫变窄，从而确诊为Mirizzi综合征。计划进行择期腹腔镜胆囊切除术。手术中，由于胆囊三角区严重局部炎症，难以在胆囊管周围进行解剖，因此采用经胆囊漏斗部入路。打开胆囊颈部，通过可弯曲的胆总管镜用碎石术取出结石。经胆囊管探查胆总管正常。切除胆囊底部和体部，随后放置T管引流并缝合胆囊颈部。患者术后临床过程顺利。即使是开放手术，治疗Mirizzi综合征对于肝胆专科医生来说仍是一项重大挑战，因为其并发症发生率高，包括胆管损伤。治疗主要是清除责任结石和坏死组织。由于内镜手术和设备的进步，腹腔镜胆囊取石次全胆囊切除术为Mirizzi综合征患者提供了一种安全有效的选择。腹腔镜次全胆囊切除术联合电液压碎石术是一种治疗Mirizzi综合征的可行且有用的方法，可避免医源性胆管损伤。
