Mirizzi's Syndrome: Retrospective Analysis of 17 Cases

Mirizzi氏症候群：17例之回顧分析

林裕鴻(Yuh-Horng Lin) ； 牟聯瑞(Lein-Ray Mo) ； 曾立榮(Li-Jung Tseng) ； 林逸文(Yie-Wen Lin) ； 楊達明(Ta-Ming Young) ； 趙瑞和(Jui-Ho Chao) ； 蔡建中(Chien-Chung Tsai)

《中華民國消化系醫學雜誌》 17卷4期 (2000/12) Pp. 257-262

https://doi.org/10.6557/GJTb.200012_17(4).0003

摘要

Mirizzi氏症候群乃膽石症罕見但重要之併發症，因膽結石緊壓在膽囊頸或瞻囊管，造成總肝管受壓迫發炎，導致限塞性黃膽。回顧17位病人臨床病史、診斷過程、引流與手術處置，藉特徵性的膽管X光影像診斷Mirizzi氏症候群。自民國83年9月至民國88年8月，2095位病人接受ERCP檢查，其中17例(0.81%)經診斷為Mirizzi氏症候群第一型。病人平均年齡為58.1歲，女性病人有4位，15位病人接受手術。術前超音波Mirizzi氏症候群診斷率爲12%，電腦斷層Mirizzi氏症侯群診斷率爲14%。ERCP顯示5位之膽囊管與總肝管接合點偏低，9位手術病人有術前引流處置。兩位不適合手術者，一人接受長期總膽管支架放置，另一人在經皮穿肝膽道鏡手術後將膽囊管結石取出，有兩位病人在ERCP後有併發症。ERCP提供診斷、分類及手術參考，總膽管或膽囊之膽汁引流使病人得以在非緊急狀態下接受開刀治療，對於不適合手術者ERCP提供有效引流及結石取出之可能。膽石症病人發生Mirizzi氏症侯群的機率雖然不大，但若術前未做正確診斷，常造成術後總膽管狹窄等併發症。

關鍵字

Mirizzi氏症候群 ； 經內視鏡逆行性膽胰管造影術(ERCP)

並列摘要

Mirizzi's syndrome is a rare complication of cholelithiasis and consists of obstruction of the common hepatic duct due to a stone impacted in the cystic duct or gallbladder 2095 patients evaluated by endoscopic retrograde cholangiopancreatography (ERCP) in Tainan Municipal Hospital over the last 5 years yielded 17 cases (0.8%) suffering from Mirizzi's syndrome. 15 patients underwent surgical intervention. Their endoscopic retrograde cholangiograms, clinical features and outcome were reviewed. Seventeen patients had a cholangiographic diagnosis of Mirizzi's syndrome type I (McSherry's classification). Of these, 5 patients had a low cystic duct insertion with the common hepatic duct. The mean age was 58.1 years (range 36-98); 4 were females. 15 patients were referred for surgery and 9 of these patients had preliminary drainage. The detection rate of Mirizzi's syndrome was 12% in ultrasonography and 14% in computed tomography respectively. One patient received long term stenting, while extraction of the cystic duct stone was performed in the rest of the patients using a combination of percutaneous transhepatic cholangioscopic surgery and endoscopic therapy. Complications occurred in 2 of 17 cases after ERCE Preoperative diagnosis of Mirizzi's syndrome is important to plan a surgical strategy and to avoid complication. ERCP allows diagnosis and classifications of Mirizzi's syndrome; therapeutic endoscopy provides temporary biliary drainage and stones extraction in poor surgical risk candidates.

並列關鍵字

Mirizzi's syndrome ； endoscopic retrograde cholangiopancreatography