Abstract：
A 76-year-old man presented with liver dysfunction and intrahepatic bile duct dilatation. Imaging studies showed two large stones that had become impacted in the common hepatic duct, which was fused with the gallbladder. The patient was diagnosed with Mirizzi syndrome type IV. Hepaticojejunostomy and stone removal failed due to dense gallbladder adhesions involving the right hepatic artery. The bile flow was temporarily restored; however, the patient experienced cholangitis 16 months later. The stones were extracted via peroral single-operator cholangioscopy (SOC)-guided electrohydraulic lithotripsy. This is the first case in which stones were completely removed by SOC-guided treatment in a patient with Mirizzi syndrome type IV.
摘要：
一名76岁男子出现肝功能障碍和肝内胆管扩张。影像学研究显示，两个大石头已经在肝总导管中受到影响，与胆囊融合。患者被诊断为IV型Mirizzi综合征。由于累及右肝动脉的胆囊粘连，肝空肠吻合术和结石清除失败。胆汁流量暂时恢复；然而，16个月后，患者出现胆管炎。通过经口单人胆道镜（SOC）引导的电动液压碎石术取出结石。这是第一个在Mirizzi综合征IV型患者中通过SOC指导治疗完全清除结石的病例。
