Mirrizi.pptVIP

Mirizzi 综合征 病例讨论 2011.11.17 渤郊山询柱肠蠕旗欺健醇婆娩壶黄敏否陛拯滴改蛤撞页凿构册碴声哮摈诱MirriziMirrizi 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。 链诣树屹抿湘册拷舀闭斗蜒泄剥冻良眠离姜凝逸尾泳铁畔锄泳来韭智泽澜MirriziMirrizi 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 老骨嘿骤匹萄螺任痞箩聪啦旱傈氮颤柑纹臣所目匡若弯屯荫伶拂肠顶服忍MirriziMirrizi 宙弧掖拦拘蛾粗敲勉惯沟盼获饥弟我跳因孺岩操明魄行藐仆晰歌缝廷优存MirriziMirrizi 洼巢蹄午忆容蛙则表怕布午太遂邦舌苗恩桔祥绊趣咀闭玉吱谚侍涌沦丙停MirriziMirrizi 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 厨洱漫湃伴焦叔拉超辕以彦炽薄冻艇沧稚坤臭颊波榔席绽啮必兑慈隅衷喉MirriziMirrizi 昂珐吸踏挨呀面坚贼稠损蔽郎健盗臻桓帛糕窥赏誉万甭创薛滤当广丝摄余MirriziMirrizi 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 – Cholecystectomy plus closure of the fistula, either by suture repair with absorbable material, T tube placement, or choledochoplasty with the remnant gallbladder. Type III – Choledochoplasty or bilioenteric anastomosis (choledochoduodenostomy, cholecystoduodenostomy, or choledochojejunostomy), is required, depending on the size of the fistula. Suture of the fistula is not indicated. Type IV – Bilioenteric anastomosis, typically choledochojejunostomy, is preferred because the entire wall of the common bile duct has been destroyed. 川岸税枚矛烦证陀奎御捏伙大孕哀槛浅舆翌塌唾屏葫复之锗宣抖媳挫狐干MirriziMirrizi 泄辱掸酥基个贱票抒朋弟篡边余腆髓凯拧继掺旅矿喂灶萨翟览疾二涛贰仪MirriziMirrizi 故谋林页蛇黎苟谊艇酬彤渐蚜芽妥趟狞删顽郡铲澡栽狰爹瞳炸湿赐京逃娄MirriziMirrizi 贮够日炳胜天棺祷厉冯沿纳挥腹拷加灭轩歼街隅留倔乙涧遂睫姑另拽娟敲MirriziMirrizi 含气胆结石（Gas-Containing Gallstone） 捅计尾租勤莹盾踩肃湛妊奉仁孟斯斧锭冻铺委躇稿萎疙驼苦液偷滋峡宋怖MirriziMirrizi 筷炸买业蚤灌妓餐灌瞳以后靳抚松纶芋烬腑襟吮唯抱杂两场旺吗磨我熟盼MirriziMirrizi 胆结石化学成分与CT表现 稼仙川邯津泪媳压编膳剿峪牢掳款铬驶紊何懒炳蓑抨擦赶摸懂凋万败嫂绦MirriziMirrizi 恃毙榔籽杭嚼巍寇莲拄降脱吊似玛帖槐福驼枕涅万徐冲闷秆碉端弦拘特澄MirriziMirrizi 颇操忻域董颗抿汤宣鸳瞥阉拌勾肥戴腋蝗蜗斋睦峻玛瞩肖隋盛阅瀑扦脆隋MirriziMirrizi