摘要
目的总结分析Mirizzi综合征（Mirizzi syndrome,MS）的临床特点。方法对5例误诊为肝门部胆管癌的MS患者临床表现、实验室检查、影像学检查等临床资料进行回顾性分析。结果 5例患者均因黄疸就诊,其中4例伴腹痛、腹胀、食欲减退,1例伴有反复发热;血清总胆红素、肿瘤标志物糖链抗原19-9均升高;影像学检查提示肝门部胆管占位性病变并肝内胆管扩张,4例合并胆囊结石,1例合并胆囊结石、肝内外胆管结石;术前均误诊为肝门部胆管癌,经开腹探查手术并经组织病理检查证实为MS;4例行胆囊切除＋胆管探查＋T管引流术,1例行胆囊切除＋胆管切开取石＋胆管空肠Rou-en-Y吻合＋肠肠侧侧吻合＋肠粘连松解术;留置T管引流3~6个月,术后均未出现并发症。结论 MS是一种特殊类型的胆囊结石,其发生与胆囊管先天性解剖变异相关;MS临床表现缺乏特异性,当患者出现黄疸、糖链抗原19-9升高及影像学提示肝门部胆管占位时,应高度警惕MS的可能。
Objective To analyze and summarize the clinical characteristics of Mirizzi syndrome（MS）.Methods The clinical manifestations,laboratory examination and imaging examination results were retrospectively analyzed in 5patients with MS misdiagnosed as hilar cholangiocarcinoma.Results Five patients visited hospital due to jaundice,in which 4patients were complicated with abdominal pain,abdominal distension and loss of appetite,and 1patient was complicated with repeated fever.The levels of serum total bilirubin and carbohydrate antigen 19-9increased in all patients.Imaging scan revealed hilar bile duct lesions with intra-hepatic cholangiectasis,in which 4 patients were complicated with gallbladder stones,and 1was complicated with gallbladder stones,and intra-and extra-hepatic bile duct stones.All were misdiagnosed as hilar cholangiocarcinoma and were confirmed MS by the surgery and histopathological examination.Four patients underwent cholecystectomy ＋ bile duct exploration ＋ T-tube drainage, and 1 patient underwent cholecystectomy＋ choledochotomy＋ bile duct jejunum Rou-en-Y anastomosis＋intestinal anastomosis＋ enterolysis.All patients received T-tube drainages for 3to 6months,and there were no complications after operation.Conclusion MS is a special type of cholecystolithiasis,and is associated with congenital anatomic variations of cystic duct.The clinical manifestations are not specific.Jaundice,elevated carbohydrate antigen 19-9level and hilar occupation on imaging scanning indicates the possible development of MS.
出处
《中华实用诊断与治疗杂志》
2015年第4期364-366,共3页
Journal of Chinese Practical Diagnosis and Therapy
