Analysis of Preoperative Diagnosis and Surgical Treatment Strategies for Different Types of Mirizzi Syndrome (Report of 86 Cases)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Xun , LI Yumin , ZHOU Wence , ZHANG Lei , MENG Wenbo , HE Mingyan , ZHU Kexiang , ZHU Youquan , LI Shixiong , PU Xiaojin , LI Qiong.

The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, China;

Corresponding author：

Keywords：

Mirizzi syndrome; Diagnosis; Csendes typing; Surgical treatment

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Objective To analyze the preoperative diagnosis and the operative methods for different types of Mirizzi syndrome (MS). Methods Eighty-six cases of MS confirmed by operation were enrolled from March 1990 to December 2008. Their laboratory examination results and X-ray appearances of endoscopic retrograde cholangiopancreatography (ERCP) were analyzed as well as B-ultrasonography (B-us), CT scan and magnetic resonance cholangiopancreatography (MRCP). According to the Csendes typing, different operative methods were adopted. Results The final diagnosis rate by ERCP for MS attained approximately 85.71% (48/56) in contrast with 17.44% (15/86) by B-us, with 9.52% (4/42) by CT scan and with 71.88%（23/32） by MRCP. Twenty cases were Csendes type Ⅰ, 43 cases were type Ⅱ, 17 cases were type Ⅲ, and 6 cases were type Ⅳ. According to the Csendes typing, the cases of type Ⅰ were treated by for the cholecystectomy or partial resection for reserving the neck of gallbladder, type Ⅱ by fistula reparation and laying up the T type drainage-tube under the fistula, and type Ⅲ and type Ⅳ by the hepaticocholangiojejunostomy and hepaticoduodenostomy. Conclusion The preoperative diagnosis for MS is very difficult, B-us may be acted as an accessory diagnostic method. ERCP and MRCP can improve the rate of preoperative diagnosis for MS strikingly. The best reasonable method of the operative therapy is selected according to the different pathologic type of MS.

Citation： LI Xun,LI Yumin,ZHOU Wence,ZHANG Lei,MENG Wenbo,HE Mingyan,ZHU Kexiang,ZHU Youquan,LI Shixiong,PU Xiaojin,LI Qiong.. Analysis of Preoperative Diagnosis and Surgical Treatment Strategies for Different Types of Mirizzi Syndrome (Report of 86 Cases). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(5): 393-396. doi: Copy

1.	Ahlawat SK, Singhania R, Al-Kawas FH. Mirizzi syndrome [J]. Curr Treat Options Gastroenterol, 2007; 10(2): 102-110.
2.	李汛, 李玉民, 朱有全, 等. 内镜逆行胰胆管造影对Mirizzi综合征的诊断价值 [J]. 中华消化内镜杂志, 2000; 17(2): 74-75.
3.	Aydin U, Yazici P, Ozsan I, et al. Surgical management of Mirizzi syndrome [J]. Turk J Gastroenterol, 2008; 19(4): 258-263.
4.	耿远兴, 耿莉. Mirizzi综合征术中胆管损伤原因及处理对策 [J]. 中国普外基础与临床杂志, 2006; 13（1）: 55.
5.	曹农, 李汛, 李玉民, 等. 52例Mirizzi 综合征的内镜诊断及手术治疗分析 [J]. 中华肝胆外科杂志, 2002; 8(6): 377-378.
6.	Yonetci N, Kutluana U, Yilmaz M, et al. The incidence of Mirizzi syndrome in patients undergoing endoscopic retrograde cholangiopancreatography [J]. Hepatobiliary Pancreat Dis Int, 2008; 7(5): 520-524.
7.	Yeh CN, Jan YY, Chen MF. Laparoscopic treatment for Mirizzi syndrome [J]. Surg Endosc, 2003; 17(10): 1573-1578.
8.	Csendes A, Díaz JC, Burdiles P, et al. Mirizzi syndrome and cholecystobiliary fistula: a unifying classification [J]. Br J Surg, 1989; 76(11): 1139-1143.
9.	马毅, 吴佩, 张应开, 等. Mirizzi综合征的临床处理 [J]. 中国普外基础与临床杂志, 2003; 10（2）: 155-156.
10.	Safioleas M, Stamatakos M, Safioleas P, et al. Mirizzi Syndrome: an unexpected problem of cholelithiasis. Our experience with 27 cases [J]. Int Semin Surg Oncol, 2008; 5: 12.
11.	吴学民. Mirizzi综合征诊治体会 [J]. 肝胆外科杂志, 2008; 16(1): 56-57.
12.	谢贻祥. Mirizzi综合征临床诊治探讨 [J]. 肝胆胰外科杂志, 2007; 19(6): 403-404.
13.	Paoloni A, Bucchianeri A, Mazzocconi G. Mirizzi syndrome. Case report [J]. G Chir, 2008; 29(3): 93-97.
14.	Sánchez Beorlegui J, Monsalve Laguna E, Soriano Gil-Albarellos P, et al. Mirizzi syndrome associated with complicated cholelitiasis in the elderly patient. Diagnosis and laparoscopic treatment [J]. Rev Gastroenterol Peru, 2008; 28(1): 15-21.
15.	张建平, 倪家连. Mirizzi综合征21例临床分析 [J]. 中国普外基础与临床杂志, 2006; 13（4）： 391-392.
16.	李晓，戈佳云，崔江云. Mirizzi综合征临床诊治体会(附38例报道) [J]. 中国普外基础与临床杂志, 2008; 15(7): 522-523.
17.	Sianesi M, Soliani P, Dell’Abate P, et al. The Mirizzi syndrome. Analysis of an unknown complication of the gallstones [J]. Ann Ital Chir, 2007; 78(5): 419-425.
18.	Beltran MA, Csendes A, Cruces KS. The relationship of Mirizzi syndrome and cholecystoenteric fistula: validation of a modified classification [J]. World J Surg, 2008; 32(10): 2237-2243.
19.	Johnson LW, Sehon JK, Lee WC, et al. Mirizzi’s syndrome: experience from a multi-institutional review [J]. Am Surg， 2001; 67(1): 11-14.
20.	Colovic ＇ R, Milosavljevic ＇ T, Zogovic ＇ S. The Mirizzi syndro-me-from the first description until today [J]. Acta Chir Iugosl, 2001; 48(1): 65-69.
21.	杨建青, 潘光栋, 王晓源, 等. Mirizzi综合征的手术治疗 [J]. 中国普通外科杂志, 2008; 17(2): 124-126.
22.	蒋晓忠, 李富贵, 严律南. Mirizzi综合症的诊断与治疗(附46例临床分析) [J]. 华西医学, 2006; 21（3）: 481.
23.	Chatzoulis G, Kaltsas A, Danilidis L, et al. Mirizzi syndrome type Ⅳ associated with cholecystocolic fistula: a very rare condition—report of a case [J]. BMC Surg, 2007; 7: 6.
24.	Waisberg J, Corona A, de Abreu IW, et al. Benign obstruction of the common hepatic duct (Mirizzi syndrome): diagnosis and operative management [J]. Arq Gastroenterol, 2005; 42(1): 13-18.

1. Ahlawat SK, Singhania R, Al-Kawas FH. Mirizzi syndrome [J]. Curr Treat Options Gastroenterol, 2007; 10(2): 102-110.
2. 李汛, 李玉民, 朱有全, 等. 内镜逆行胰胆管造影对Mirizzi综合征的诊断价值 [J]. 中华消化内镜杂志, 2000; 17(2): 74-75.
3. Aydin U, Yazici P, Ozsan I, et al. Surgical management of Mirizzi syndrome [J]. Turk J Gastroenterol, 2008; 19(4): 258-263.
4. 耿远兴, 耿莉. Mirizzi综合征术中胆管损伤原因及处理对策 [J]. 中国普外基础与临床杂志, 2006; 13（1）: 55.
5. 曹农, 李汛, 李玉民, 等. 52例Mirizzi 综合征的内镜诊断及手术治疗分析 [J]. 中华肝胆外科杂志, 2002; 8(6): 377-378.
6. Yonetci N, Kutluana U, Yilmaz M, et al. The incidence of Mirizzi syndrome in patients undergoing endoscopic retrograde cholangiopancreatography [J]. Hepatobiliary Pancreat Dis Int, 2008; 7(5): 520-524.
7. Yeh CN, Jan YY, Chen MF. Laparoscopic treatment for Mirizzi syndrome [J]. Surg Endosc, 2003; 17(10): 1573-1578.
8. Csendes A, Díaz JC, Burdiles P, et al. Mirizzi syndrome and cholecystobiliary fistula: a unifying classification [J]. Br J Surg, 1989; 76(11): 1139-1143.
9. 马毅, 吴佩, 张应开, 等. Mirizzi综合征的临床处理 [J]. 中国普外基础与临床杂志, 2003; 10（2）: 155-156.
10. Safioleas M, Stamatakos M, Safioleas P, et al. Mirizzi Syndrome: an unexpected problem of cholelithiasis. Our experience with 27 cases [J]. Int Semin Surg Oncol, 2008; 5: 12.
11. 吴学民. Mirizzi综合征诊治体会 [J]. 肝胆外科杂志, 2008; 16(1): 56-57.
12. 谢贻祥. Mirizzi综合征临床诊治探讨 [J]. 肝胆胰外科杂志, 2007; 19(6): 403-404.
13. Paoloni A, Bucchianeri A, Mazzocconi G. Mirizzi syndrome. Case report [J]. G Chir, 2008; 29(3): 93-97.
14. Sánchez Beorlegui J, Monsalve Laguna E, Soriano Gil-Albarellos P, et al. Mirizzi syndrome associated with complicated cholelitiasis in the elderly patient. Diagnosis and laparoscopic treatment [J]. Rev Gastroenterol Peru, 2008; 28(1): 15-21.
15. 张建平, 倪家连. Mirizzi综合征21例临床分析 [J]. 中国普外基础与临床杂志, 2006; 13（4）： 391-392.
16. 李晓，戈佳云，崔江云. Mirizzi综合征临床诊治体会(附38例报道) [J]. 中国普外基础与临床杂志, 2008; 15(7): 522-523.
17. Sianesi M, Soliani P, Dell’Abate P, et al. The Mirizzi syndrome. Analysis of an unknown complication of the gallstones [J]. Ann Ital Chir, 2007; 78(5): 419-425.
18. Beltran MA, Csendes A, Cruces KS. The relationship of Mirizzi syndrome and cholecystoenteric fistula: validation of a modified classification [J]. World J Surg, 2008; 32(10): 2237-2243.
19. Johnson LW, Sehon JK, Lee WC, et al. Mirizzi’s syndrome: experience from a multi-institutional review [J]. Am Surg， 2001; 67(1): 11-14.
20. Colovic ＇ R, Milosavljevic ＇ T, Zogovic ＇ S. The Mirizzi syndro-me-from the first description until today [J]. Acta Chir Iugosl, 2001; 48(1): 65-69.
21. 杨建青, 潘光栋, 王晓源, 等. Mirizzi综合征的手术治疗 [J]. 中国普通外科杂志, 2008; 17(2): 124-126.
22. 蒋晓忠, 李富贵, 严律南. Mirizzi综合症的诊断与治疗(附46例临床分析) [J]. 华西医学, 2006; 21（3）: 481.
23. Chatzoulis G, Kaltsas A, Danilidis L, et al. Mirizzi syndrome type Ⅳ associated with cholecystocolic fistula: a very rare condition—report of a case [J]. BMC Surg, 2007; 7: 6.
24. Waisberg J, Corona A, de Abreu IW, et al. Benign obstruction of the common hepatic duct (Mirizzi syndrome): diagnosis and operative management [J]. Arq Gastroenterol, 2005; 42(1): 13-18.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of Preoperative Diagnosis and Surgical Treatment Strategies for Different Types of Mirizzi Syndrome (Report of 86 Cases)

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