The Name "mirizzi syndrome" associated with the name of the surgeon from Argentina, Mirizzi, who is the author of numerous works related to the physiology of bile excretion, and clinical practitioner in the field of intraoperative cholegraphy.
In 1948, In his scientific work the doctor described the x-ray semiotics hepatic syndrome, obvious signs of which was the stasis of bile and contracture of the bile duct. Also presented were the picture of calculous syndrome, which is expressed in the appearance of a fistula between the gallbladder and hepaticocholedochus.
Not everyone is familiar with the illness, such as mirizzi syndrome. What it is, we will explain below. But first it is worth noting that so far in medicine, the notion has not been fully determined. So, many doctors believe that the disease is narrowing of the lumen of the duct in the liver. The most comprehensive formulation of the syndrome involves the identification of pathology with stenosis of the duct of the liver or region germanovicha pockets of concretion, which is accompanied by an inflammatory process in the gall bladder and is manifested in cholangitis or jaundice.
Mirizzi Syndrome, the classification of which is presented in this article, according to many scientists, is characterized not only by a narrowing of the lumen. The pathological process includes the right of equity and the common bile duct.
Absolutely different interpretations of the syndrome, scientists believe that the disease is usernameonly fistula. There are opposing views regarding the place of localization of pathological process. In some scientific papers mention the location of the ties between the gallbladder and the common duct of the liver, as in other research works are examples of the presence of fistula between the gallbladder and the common bile duct.
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For example, in the classification of M. B. Corlette, H. Bismuth (1975) presented of bilio-biliary fistula in two types depending on localization of pathological anastomosis (above or below the main connection of bile and the cystic duct).
Some researchers attribute the manifestation of disease by the narrowing of the lumen of the extrahepatic bile ducts and the formation of a fistula cholecystolithiasis.
A Variety of interpretation of the essence of the syndrome is difficult to see its essence and weight search for effective methods of its treatment.
In recent years, can often come across a new interpretation of such pathology, as a mirizzi syndrome? Types it is represented by two variants of the disease:
The Classical description of such a pathological process as the mirizzi syndrome, photos of which are presented in this article has four main points:
What kinds of classified this disease as a mirizzi syndrome? Classification involves the level of destruction of the wall of the main duct of the liver userlocaleparam they hiss (Csendes):
The Main causes of such diseases as mirizzi syndrome, are:
Depending on the structure of biliary ducts, the size and weight of the stones and methods of therapy process may be suspended for any of the above stages, but the transformation from a slight compression of the bile duct in the gallbladder choledochotomy the fistula could only be observed with gallstone disease.
Compression of the bile duct degenerates in stricture if delayed surgical intervention, and the disease acquires a chronic form, in which the period of remission is replaced by aggravation. After a time the wall of the gallbladder and extrahepatic bile ducts come into contact that provoked a large stone in germanasca pocket. Under the pressure of his weight deteriorating trophic arisesdecubitus ulcer of the gall bladder wall and duct. Then formed usernameonly fistula.
Through such pathological messages from the gallbladder into the lumen of the extrahepatic bile ducts into stones. Fistula is increased in diameter by reducing its tissue in the area of compression. As a result, the narrowing of the proximal part of the extrahepatic bile ducts removed gallbladder decreases in size, disappears his neck, germanovsky pocket, and a large part of the body. The result of the gallbladder becomes like diverticulities education, which has communication with the lumen of the extrahepatic bile duct by means of a wide anastomosis. Typically, the duct of the bladder is missing.
What is the mirizzi syndrome? The symptoms of cholecystitis, occurring in acute or chronic form with the development of mechanical forms of jaundice. In the vast number of patients in your medical history it is noted additionally, the existing gallstone disease with frequent attacks alternating with periods of mechanical forms of jaundice. About scientific data are the most frequently manifested symptoms are pain in the upper right abdomen. Pain and jaundice are concerned in 60-100 % of cases.
Often jaundice occurs in the presence of vesico-choledochal fistula.
When marked cholangitis fever. Sometimes concerned about pain in the region of the hypochondrium, intoxication, development of pancreatitis (acts like layering on a common disease). In the blood bilirubin, ALT, AST and alkaline phosphatase.
Mirizzi Syndrome occurs in 0.1% of patients with gallstone disease. When surgical intervention is noted in the 0.7-2.5% of patients. Sick men and women of all races and Nations. In old age, the disease occurs much more frequently.
What is the complexity of treatment of this pathology, as a mirizzi syndrome? Diagnosis and surgical strategy has not been fully determined.
In modern medicine there are no generally accepted rules for the conduct of diagnostic procedures. Despite progress in medical imaging of various diseases, diagnosis before the operation is established with difficulty. It fails about 20 % of cases. Only a few researchers have noted that ultrasound examination of the disease before the operation reaches the exact figure of 67.1% of cases, MRI 94.4%, vnutriportovaya ultrasound – in 97% and endoscopic retrograde cholangiopancreatography – 100%.
All of this suggests that modern methods of instrumental diagnostics does not always provide an opportunity to identify the syndrome Merisi in the period preceding the operation.
Most Often, when ultrasound meet the following characteristics:
KT-indicators of mirizzi syndrome coincide with the symptoms that appear during ultrasonic diagnosis. Although CT can not provide important information, complementary to the ultrasonic method, its role in determining the presence of a malignant tumor in the region of the proximal ducts of the gallbladder is quite high, which is important in the differentiation syndrome Merisi with cancer.
Magnetic resonance imaging, endoscopy and retrograde cholangiopancreatography (ERCP) are equivalent to diagnostic methods for identifying elements cholecystolithiasis stricture and fistula. The images shot in mode T1 and T2 are a more accurate way to distinguish inflammation from cancer that is not always a virtue CT and ultrasound. However, due to the high price of examination by MRI this diagnostic method was not applied in all medical centers.
Magnetic resonance cholangiopancreatography is a relatively new but little-studied type of diagnosis. A number of scholars consider it as the most promising species for the designation of such pathology, as a syndrome Merisi.
Some scientists in their labors to note the advantages of laparoscopic ultrasound of the pancreaticoduodenal region. Surgery for suspected cm, this method of diagnosis makes it possible in real time to build an image of the biliary ducts in multiple planes the fruit of a different angle. Currently, however, this method remains inaccessible and unexplored until the end.
It Should be noted that, despite the availability of various diagnostic methods, to establish the presence of CM is still extremely difficult, which may mislead the surgeon and cause injury to the common bile duct, which is mistakenly perceived as a gallbladder or wide duct. The lack of generally accepted methods of diagnosis before surgery is pushing for the development of optimal methods.
It eliminates the mirizzi syndrome? Treatment involves two main areas: rentgenograficheskie method and surgical intervention.
Rentgenograficheskie treatment can be applied as an initial stage before surgery in preparation for surgery. Itacts as an independent modality for the treatment of patients with CM in the case of high anesthesiological risk.
The disadvantages of REV many researchers include:
According to the scientific literature vary greatly between the types of surgical intervention. There are various options of surgery in CM.
Some doctors believe that treating syndrome Merisi and laparoscopy is absolutely contraindicated.
For the more common form of operation for the first type syndrome is a cholecystectomy, which is complemented by drainage of the common bile duct.
As docked in the presence of binibilang the fistula mirizzi syndrome? Situational task requires the separation and subsequent recovery of the integrity of choledocho. As one of the ways of closing the common bile duct, which is used by most surgeons, is the elimination of the defect walls by means of the left part of the gallbladder. However, some doctors believe that abandoned fabric can increase the risk of residual choledocholithiasis.
The presence of a fistula cholecystoduodenal recommended to perform plastic surgery on the common bile duct stents are only temporary. The need for this type of operation many scientists explain the presence of long flowing changes of inflammatory nature in the area hepatoduodenal ligaments, allowing the SM can be regarded as a damage model of the walls of the bile ducts. When significant deformation of the wall of the bile duct involved in the fistula.
During a surgical intervention there is a high level of risk of complications.
Most Often occurs after surgery complications such as stricture of the common bile duct. According to the Russian researcher G. I. Draganova (2009), from 46 patients who underwent surgery, the stricture occurred in 6.5 per cent.
What are the results of the operation on the so-called lost drainage, which was made of four patients with the initial form, SEE (strazny view)? Researchers V. S. Savel'ev, V. I. Revyakin (2003) noted positive dynamics of the disease, however, explain the removal of the drainage system of the region of the duct for the following reasons:
The highest degree of difficulties in performing surgery on patients with a high degree of destruction of the wall of the common bile duct. If the disease is located on the third or fourth stage, there was a higher mortality rate after surgery. When the disease is located in the third or fourth degree, most surgeons are in favor of holding choledochojejunoanastomosis.
As docked the mirizzi syndrome? Treatment after surgery involves the surrender of General analysis of blood the next day after surgery, a week and a day before discharge from the hospital. The stitches are removed on day 10.
The Average length of stay of patients in hospital is around 10-12 days. The total duration of the recovery period is two months.
Usually, patients are shown stay in the resort in the rehabilitation unit.
Nowadays the mirizzi syndrome, classification, diagnosis, treatment of which is described in this article, medicine is considered as one of the complications of gallstone disease. However, in the field of diagnosis and surgical intervention remain a number of unsolved questions.
Despite the fact that there is a wide range of different types of surgery, the treatment results do not always respond as expected.
During operation increases the level of intra - and postoperative complications.
Difficulties in the conduct of diagnostic procedures, the risk of damaging the bile duct, a small number of observations, as well as a wide range of methods of surgical intervention are a precondition for a more in-depth study of the problem.
The Introduction of modern principles of diagnosis and development of optimal tactics of surgery depending on the stage of the disease gives an opportunity to optimize therapy of patients with this complication of cholelithiasis.
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JA: https://tostpost.com/ja/health/1754-mirizzi.html
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TR: https://tostpost.com/tr/sa-l-k/3042-sendromu-mirizzi-s-n-fland-rma-tan-tedavi.html
UK: https://tostpost.com/uk/zdorov-ya/3039-sindrom-mirizzi-klasif-kac-ya-d-agnostika-l-kuvannya.html
Alin Trodden - author of the article, editor
"Hi, I'm Alin Trodden. I write texts, read books, and look for impressions. And I'm not bad at telling you about it. I am always happy to participate in interesting projects."
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