Peterli R, Geering P, Huber A K
Chirurgische Klinik Kantonsspital Bruderholz.
Swiss Surg. 1995(6):298-303; discussion 303.
The Mirizzi syndrome describes a benign obstruction of the common hepatic duct due to a stone impacted within the cystic duct or in the Hartman's pouch of the gall bladder. The obstruction is caused either by external compression (Type I) or due to arrosion of the common hepatic wall creating a cholecysto-biliary fistula (Type II-IV). In a period of 16 months we encountered this rare cause of obstructive jaundice four times. We discuss the importance of preoperative diagnosis and a safe surgical management. Ultrasonography together with the laboratory findings of obstructive jaundice may lead to the suspicion of a Mirizzi syndrome. Often the endoscopic retrograde cholangiography confirms the diagnosis. Some authors report the successful treatment of Mirizzi syndrome by laparoscopic surgery. Nevertheless, we propose the open procedure because of the presence of dense inflammatory adhesions at the junction between the gallbladder and the common hepatic duct. Biliary-enteric bypass is often required to establish a sufficient biliary drainage. We consider laparoscopic techniques to be too dangerous.
Mirizzi综合征是指由于结石嵌顿于胆囊管或胆囊Hartmann袋内导致肝总管的良性梗阻。梗阻是由外部压迫（I型）或肝总管壁侵蚀形成胆囊胆管瘘（II - IV型）所致。在16个月的时间里，我们4次遇到这种导致梗阻性黄疸的罕见病因。我们讨论了术前诊断的重要性及安全的手术处理方法。超声检查结合梗阻性黄疸的实验室检查结果可能会引发对Mirizzi综合征的怀疑。内镜逆行胆管造影术常常能确诊。一些作者报道了通过腹腔镜手术成功治疗Mirizzi综合征的案例。然而，由于胆囊与肝总管交界处存在致密的炎性粘连，我们建议采用开放手术。通常需要行胆肠吻合术以建立充分的胆汁引流。我们认为腹腔镜技术过于危险。
