Mirrizi.pptVIP

Mirizzi 综合征 病例讨论 2011.11.17 胆囊管或胆囊颈部结石压迫肝总管引起胆道梗阻症状，伴/不伴胆管瘘形成。 在胆囊切除患者中发病率0.7%~1.8%。 男女发病率无明显差异，老年患者多见。 引起胆管梗阻的机制 机械性梗阻 （胆囊管与肝总管位置靠近） 继发胆管炎症 按是否合并胆管瘘分为两型： Type I - No fistula present IA - Presence of the cystic duct IB - Obliteration of the cystic duct Types II-IV - Fistula present II - Defect smaller than 33% of the CBD diameter III - Defect 33-66% of the CBD diameter IV - Defect larger than 66% of the CBD diameter 推荐治疗方案： Type I – Partial or total cholecystectomy, either laparoscopic or open. Common bile duct exploration is typically not required Type II –