Redaelli C A, Büchler M W, Schilling M K, Krähenbühl L, Ruchti C, Blumgart L H, Baer H U
Department of Visceral and Transplantation Surgery, University of Bern, Switzerland.
Surgery. 1997 Jan;121(1):58-63. doi: 10.1016/s0039-6060(97)90183-5.
Mirizzi syndrome is a rare complication of long-standing cholelithiasis. It is defined as obstructive jaundice caused by external compression of the common hepatic duct by an impacted stone in the gallbladder neck. Gallstone disease and cholelithiasis-associated chronic biliary inflammation may play a causative role in the pathogenesis of gallbladder carcinoma. The purpose of this study was to investigate the coincidence of gallbladder carcinoma associated with Mirizzi syndrome. Furthermore, the diagnostic value of elevated CA 19-9 levels as indicator for a coincidental gallbladder carcinoma in this syndrome was studied.
Patient demographics, clinical findings, laboratory data, results of diagnostic studies, pathologic reports, and intraoperative findings of 1579 patients undergoing cholecystectomy were obtained from patient records and were retrospectively studied. Only patients with proven Mirizzi syndrome (i.e., extrinsic mechanical compression of the common hepatic duct by impacted gallstones, associated chronic cholecystitis, and a history of jaundice) were included in this study.
Eighteen cases of Mirizzi syndrome (1.0%) out of 1759 cholecystectomies performed between January 1986 and March 1995 were identified. The seven male patients and 11 female patients had an average age of 74.8 years (range, 32 to 87 years). In five of these patients (27.8%) coincidental cases of gallbladder carcinoma were detected. The incidence of unsuspected malignancies in long-standing gallstone disease was 36 (2%) of 1759 and was statistically significantly different (p < 0.001) from the incidence in patients with Mirizzi syndrome (27.8%, 5 of 18). No significant difference was noted in age, gender, duration of jaundice, and type of lesions between these two groups. Tumor-associated antigen CA 19-9 level was elevated in 12 patients with Mirizzi syndrome, but it was significantly higher (p < 0.0001) in all five patients with coincidental gallbladder neoplasm and peaked at 1000 units/ml. All patients diagnosed with gallbladder carcinoma died within 18 months after operation.
There is high association of gallbladder cancer in Mirizzi syndrome. Elevated CA 19-9 levels in this syndrome are indicative of a coincidental gallbladder malignancy. Because of this high coincidence of Mirizzi syndrome and gallbladder cancer we recommend an intraoperative frozen section of the gallbladder in all patients presenting with Mirizzi syndrome.
Mirizzi综合征是长期胆结石的一种罕见并发症。它被定义为胆囊颈部嵌顿结石对肝总管造成外部压迫导致的梗阻性黄疸。胆结石疾病和胆结石相关的慢性胆道炎症可能在胆囊癌的发病机制中起致病作用。本研究的目的是调查Mirizzi综合征合并胆囊癌的情况。此外，还研究了CA 19-9水平升高作为该综合征合并胆囊癌指标的诊断价值。
从患者记录中获取1579例行胆囊切除术患者的人口统计学资料、临床发现、实验室数据、诊断研究结果、病理报告和术中发现，并进行回顾性研究。本研究仅纳入经证实患有Mirizzi综合征的患者（即嵌顿胆结石对肝总管的外部机械压迫、相关慢性胆囊炎和黄疸病史）。
在1986年1月至1995年3月期间进行的1759例胆囊切除术中，确诊18例Mirizzi综合征（1.0%）。7例男性患者和11例女性患者的平均年龄为74.8岁（范围32至87岁）。在其中5例患者（27.8%）中检测到合并胆囊癌。长期胆结石疾病中未被怀疑的恶性肿瘤发生率为1759例中的36例（2%），与Mirizzi综合征患者的发生率（27.8%，18例中的5例）在统计学上有显著差异（p < 0.001）。两组在年龄、性别、黄疸持续时间和病变类型方面未发现显著差异。12例Mirizzi综合征患者的肿瘤相关抗原CA 19-9水平升高，但在所有5例合并胆囊肿瘤的患者中显著更高（p < 0.0001），峰值达1000单位/毫升。所有诊断为胆囊癌的患者在术后18个月内死亡。
Mirizzi综合征与胆囊癌高度相关。该综合征中CA 19-9水平升高提示合并胆囊恶性肿瘤。由于Mirizzi综合征与胆囊癌的这种高度相关性，我们建议对所有患有Mirizzi综合征的患者术中进行胆囊冰冻切片检查。
