Becker C D, Hassler H, Terrier F
AJR Am J Roentgenol. 1984 Sep;143(3):591-6. doi: 10.2214/ajr.143.3.591.
Preoperative recognition of the Mirizzi syndrome permits avoidance of several serious pitfalls at surgery. The typical diagnostic signs of the Mirizzi syndrome are (1) dilatation of the common hepatic duct above the level of (2) a gallstone impacted in the cystic duct, with (3) normal duct width below the stone. Since jaundice is the leading clinical symptom, sonography and computed tomography (CT) are now the primary radiologic tests. The syndrome does not regularly have typical features, however, and therefore cannot be detected routinely on sonography or CT. Direct cholangiography is often necessary, especially since a cholecystobiliary fistula secondary to stone penetration into the common bile duct can be demonstrated only by cholangiography. On the other hand, direct cholangiography should follow either sonography or CT because these imaging methods are superior for demonstrating extraluminal signs of malignancy, which is the most important differential diagnosis. The findings at preoperative examinations (sonography, six; CT, four; endoscopic retrograde cholangiography, five) in seven patients with surgically confirmed Mirizzi syndrome are analyzed retrospectively.
术前识别Mirizzi综合征可避免手术中出现一些严重失误。Mirizzi综合征的典型诊断体征为：（1）肝总管在（2）胆囊管内嵌顿结石水平以上扩张，且（3）结石下方胆管宽度正常。由于黄疸是主要临床症状，超声检查和计算机断层扫描（CT）目前是主要的影像学检查方法。然而，该综合征并非总是具有典型特征，因此无法通过超声检查或CT常规检测到。直接胆管造影往往是必要的，特别是因为结石穿入胆总管继发的胆囊胆管瘘只能通过胆管造影显示。另一方面，直接胆管造影应在超声检查或CT之后进行，因为这些成像方法在显示恶性肿瘤的腔外征象方面更具优势，而恶性肿瘤是最重要的鉴别诊断。对7例经手术证实为Mirizzi综合征患者的术前检查结果（超声检查6例、CT检查4例、内镜逆行胆管造影5例）进行回顾性分析。
