mirizzi综合征影像学诊断

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1、Mirizzi综合征影像学诊断李树军(江苏省沭阳县扎下医院普外科江苏沭阳223600)【中图分类号】R445【文献标识码】A【文章编号】1672-5085(2011)48-0060-02【摘要】目的探讨各种影像学检查诊断Mirizzi综合征的准确性。方法对14例经手术证实的Mirizzi综合征术前影像学检查结果进行回顾性分析。结果B超诊断为胆囊结石11例，诊断为胆总管结石2例，诊断为Mirizzi综合征1例;6例ERCP确诊3例;5例CT检查中2例正常，诊断为肭囊结石及肭总管结石各1例,1例诊断为Mirizzi综合征；7例MRCP检查3例诊为Mirizzi练合征，诊断为胆囊管结石和胆总管

2、结石各2例。B超、ERCP、CT、MRCP诊断Mirizzi综合征的敏感性分别为7.1%(1/14)、50%(3/6)、20%(1/5)、42.9%(3/7)。结论Mirizzi综合征临床表现无特异性，正确的术前诊断需要联合多种影像学检查及提高对木病的认识。【关键词】胆囊结石Mirizzi练合征影像学诊断[Abstract]ObjectiveTodiscusstheaccuracyofvarousimagetodiagnoseMirizzisyndrome.MethodsPreoperativeimageexaminationsof14patientswithMirizzisyndrom

3、eprovedbyoperationwereanalyzedretrospectively.Results11patientswerediagnosedascholecystolithiasis,2patientsascholedocholithiasisand1patientasMirizzisyndromebyultrasonography(US);twooutoffivepatientsdetectedbycomputertomography(CT)werediagnosedasnormalandoneascommonductstone,anotherascholecystolit

4、hiasis,onlyonecasewasdiagnosedasMirizzisyndrome.Sixcasesweresubmittedtoendoscopicretrogradecholangiopancreatography(ERCP)thatrevealedMirizzisyindromeinthree;SevencasesweresubmittedtoMagneticResonanceCholangiopancreatography(MRCP)thatrevealedMirizzisyindromeinthreeandcalculusofcysticduct,choledoch

5、olithiasisintworespectively;ThesensitivityofUS,ERCP,CT,MRCPtodiagnoseMirizzisyndromewas7.1%(l/14)、50%(3/6)、20%(l/5)、42.9%(3/7).ConclusionsClinicalmanifestationofMirizzisyndromehasnospecificity,definitepreoperativediagnosisneedcombinationwithvariousimageexaminationsandtoimproverecognitionofthecond

6、ition.【Keywords]cholecystolithiasisMirizzisyndromeimagediagnosis因持续嵌顿和压迫胆囊壶腹部和胆囊颈部的结石引起肝总管狭窄或胆囊胆管瘘以及反复发作的胆囊炎、胆管炎及梗阻性黄疸称为Mirizzi综合征。其发病率约占胆囊结石的0.07〜2.7%[1】。Mirizzi综合征是一种少见病，术前诊断比较困难，不充分认识此病易导致术中胆管损伤[2】。本文总结了我院收治的14例Mirizzi绽合征的影像学表现。1一般资料收集2000-01月〜2010-04月期间我院收治并经过手术证实的Mirizzi综合征14例,其中女9例，男5例，年龄35

7、〜76岁，平均58.3岁。入院吋临床症状:右上腹痛12例,艿中典型的胆绞痛10例，黄疽8例，发热寒战6例，恶心呕吐、食欲不振5例。病史3天到35年不等，平均病程7.8年。2术前检査2.1T-Bil:14.8〜98.6μmol/L;D-Bil:9.3〜66.1μmol/L;ALT升高8例;AST升高6例;ALP升高4例。2.2影像学检查:14例全部做过B超检査，6例做过ERCP,5例做过CT,7例做过MRCPo3结果B超诊