Ibrarullah M, Saxena R, Sikora S S, Kapoor V K, Saraswat V A, Kaushik S P
Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Aust N Z J Surg. 1993 Oct;63(10):802-6. doi: 10.1111/j.1445-2197.1993.tb00344.x.
Fourteen cases of Mirizzi's syndrome are presented here. Clinical presentation was pain (14), jaundice (14), fever (10) and peritonitis (1). A clinical diagnosis of choledocholithiasis was considered in all the patients. Pre-operative diagnosis of Mirizzi's syndrome was made in five patients on the basis of cholangiogram and the remaining cases were diagnosed at surgery. The stage (type) of Mirizzi's syndrome was based on the extent of erosion of the common bile duct. Four patients had type I, seven type II and three type III lesions. Associated choledocholithiasis was present in five and acute free perforation of the gall-bladder in one. The operative procedures performed were partial cholecystectomy for type I, partial cholecystectomy, choledochoplasty and T-tube choledochostomy for type II and bilioenteric anastomosis for type III lesions. Two patients had retained common bile duct stones. Mean follow up was 14 months (range 1-27 months). One patient with secondary biliary cirrhosis continues to have persistently elevated serum alkaline phosphatase levels without any demonstrable biliary obstruction. Diagnostic and operative strategies are discussed and a follow up protocol for such patients is suggested.
本文报告了14例Mirizzi综合征病例。临床表现为疼痛（14例）、黄疸（14例）、发热（10例）和腹膜炎（1例）。所有患者均考虑临床诊断为胆总管结石。5例患者根据胆管造影术进行了Mirizzi综合征的术前诊断，其余病例在手术时确诊。Mirizzi综合征的分期（类型）基于胆总管的侵蚀程度。4例为I型，7例为II型，3例为III型病变。5例伴有胆总管结石，1例胆囊急性游离穿孔。I型行部分胆囊切除术，II型行部分胆囊切除术、胆总管成形术和T管胆总管造口术，III型病变行胆肠吻合术。2例患者有胆总管结石残留。平均随访14个月（范围1 - 27个月）。1例继发性胆汁性肝硬化患者血清碱性磷酸酶水平持续升高，无明显胆道梗阻。讨论了诊断和手术策略，并为此类患者建议了随访方案。
