1.What is Mirizzi syndrome?
It is a syndrome characterized by choledocholithiasis, obstructive jaundice and hepatic impairment caused by stenosis of the common bile duct due to an embedded gallbladder duct or gallbladder neck stone.
2.Pathological changes of Mirizzi’s syndrome?
The stone embedded in the cystic duct or gallbladder neck compresses the common hepatic duct causing stenosis, obstruction and secondary cholangitis, or its compression causes ischemic necrosis of the lateral wall of the common hepatic duct and forms a choledochal fistula.
3. What are the conditions for Mirizzi syndrome?
A long and parallel section of the cystic duct with the common bile duct.
an embedded stone in the cystic duct or in the neck of the gallbladder
compression of the bile duct by an embedded stone.
Atrophy of the gallbladder.
Dilation of the hepatobiliary ducts above the neck of the gallbladder.
deviation of the bile ducts with smooth margins of the lateral filling defect.
Sudden transformation of the dilated bile duct into a normal bile duct below the stone.
5. Magnetic resonance biliary imaging (MRCP) in Mirizzi syndrome?
shows not only the biliary tract but also the changes in its surrounding anatomy, is non-invasive, has good patient compliance and does not require contrast.
It can significantly improve the preoperative diagnosis rate of Mirizzi syndrome .
6.What is the typology of Mirizzi syndrome?
Type I: Mirizzi syndrome prototype, i.e. bile duct or gallbladder neck stones compressing the common bile duct.
Type II: Choledochocholithiasis with a fistula less than 1/3 of the circumference of the common bile duct
type III: the fistula exceeds 2/3 of the circumference of the bile duct
Type IV: cholecystocholedochal fistula completely destroys the wall of the common bile duct .
7.Treatment principles for Mirizzi syndrome?
Removal of the gallbladder.
Removal of stones.
Removal of obstruction.
Repair of bile duct defect and bile drainage.
8.Open surgical treatment of Mirizzi syndrome?
(1) cholecystectomy with lithotomy and fistula for all types of acute cholangitis conditions.
(2) Simple cholecystectomy for type I and type IV.
(3) cholecystectomy bile duct repair T-tube drainage for types II and III.
(4) cholecystectomy with bile duct jejunostomy Roux-Y anastomosis, for type II with relatively large bile duct defect and difficult bile duct repair alone .
9.Endoscopic treatment of Mirizzi syndrome?
Endoscopic papillary myotomy, extracorporeal lithotripsy, balloon dilation, mesh basket or mechanical lithotripsy, and internal stent placement can also successfully manage Mirizzi syndrome.
10. Laparoscopic treatment of Mirizzi’s syndrome.
The laparoscopic treatment can deal with Mirizzi syndrome type I and type II. Intraoperative cholangiography and laparoscopic ultrasound can make the operation safer, but Mirizzi syndrome with biliary fistula is not suitable for laparoscopic surgery.