Abstract:
Mirizzi syndrome is a serious complication of gallstone disease. It is caused by the impacted stones in the gallbladder neck or cystic duct. One of the features of Mirizzi syndrome is severe inflammation or dense fibrosis at the Calot\'s triangle. In our clinical practice, bile duct, branches of right hepatic artery and right portal vein clinging to gallbladder infundibulum are often observed due to gallbladder infundibulum adhered to right hepatic hilum. The intraoperative damage of branches of right hepatic artery occurs more easily than that of bile duct, all of which are hidden pitfalls for surgeons. Magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) are the preferable tools for the diagnosis of Mirizzi syndrome. Anterograde cholecystectomy in Mirizzi syndrome is easy to damage branches of right hepatic artery and bile duct due to gallbladder infundibulum adhered to right hepatic hilum. Subtotal cholecystectomy is an easy, safe and definitive approach to Mirizzi syndrome. When combined with the application of ERCP, a laparoscopic management of Mirizzi syndrome by well-trained surgeons is feasible and safe. The objective of this review was to highlight its existing problems: (1) low preoperative diagnostic rate, (2) easy to damage bile duct and branches of right hepatic artery, and (3) high concomitant gallbladder carcinoma. Meanwhile, the review aimed to discuss the possible therapeutic strategies: (1) to enhance its preoperative recognition by imaging findings, and (2) to avoid potential pitfalls during surgery.
摘要:
Mirizzi综合征是胆石症的严重并发症。它是由胆囊颈部或胆囊管的结石撞击引起的。Mirizzi综合征的特征之一是Calot三角处的严重炎症或密集纤维化。在我们的临床实践中,胆管,由于胆囊漏斗粘附在右肝门,经常观察到右肝动脉和右门静脉分支紧贴胆囊漏斗。术中右肝动脉分支的损伤比胆管更容易发生,所有这些都是外科医生隐藏的陷阱。磁共振胰胆管造影(MRCP)和内镜逆行胰胆管造影(ERCP)是诊断Mirizzi综合征的首选工具。Mirizzi综合征的顺行胆囊切除术易损伤右肝动脉和胆管分支,因为胆囊漏斗粘附在右肝门。胆囊大部切除术很容易,安全和确定的方法Mirizzi综合征。结合ERCP的应用,由训练有素的外科医生进行Mirizzi综合征的腹腔镜治疗是可行且安全的.本文的目的是强调其存在的问题:(1)术前诊断率低,(2)易损坏胆管和右肝动脉分支,(3)高伴发胆囊癌。同时,该综述旨在讨论可能的治疗策略:(1)通过影像学检查结果增强其术前识别,(2)避免手术过程中的潜在陷阱。