頁籤選單縮合
題 名 | Mirizzi's Syndrome: Retrospective Analysis of 17 Cases=Mirizzi氏症候群:17例之回顧分析 |
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作 者 | 林裕鴻; 牟聯瑞; 曾立榮; 林逸文; 楊達明; 趙瑞和; 蔡建中; | 書刊名 | 中華民國消化系醫學雜誌 |
卷 期 | 17:4 2000.12[民89.12] |
頁 次 | 頁12-17 |
分類號 | 415.456 |
關鍵詞 | Mirizzi氏症候群; 經內視鏡逆行性膽胰管造影術; Mirizzi's syndrome; Endoscopic retrograde cholangiopancreatography; ERCP; |
語 文 | 英文(English) |
中文摘要 | 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膽囊管 ,造成總肝管受壓迫發炎,導致阻塞性黃膽。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 氏症候群診斷率為 12%,電腦斷層 Mirizzi 氏症候群診斷率為 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 氏症候群的機率雖然不大,但若術前未做正確診斷, 常造成術後總膽管狹窄等併發症。 |
英文摘要 | Mirizzi's syndrome is a rare complication of cholelithiasls 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 (0.81%) 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 thses, 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 ERCP. 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. |
本系統中英文摘要資訊取自各篇刊載內容。