囊性导管扩张导致的肝总管压迫(CHD),是米利兹综合征的另一种变异型还是新类型?病例报告

Q3 Pharmacology, Toxicology and Pharmaceutics
V. S. Budipramana
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引用次数: 0

摘要

背景:胆石撞击胆囊管远端导致胆总管(CBD)狭窄或阻塞被称为米利兹综合征(Mirizzi Syndrome,MS)。然而,由于胆石撞击胆囊管远端导致胆囊管扩大而压迫肝总管(CHD)的病例却从未报道过。病例报告:一名 60 岁的印尼爪哇裔男子因胆总管(CHD)扩大导致胆总管结石压迫而出现梗阻性黄疸,遂来院就诊。在这种情况下,结石只是位于胆囊管的顶端,导致胆囊管阻塞,但结石并没有直接压迫肝总管。本病例中可能会出现长囊管,且囊管插入 CBD 的位置处于中间或低位。本病例的诊断是由囊性导管扩大引起的肝总管梗阻。患者接受了两次手术,第一次手术只做了胆囊切除术,第二次手术取出了残余的胆囊管,包括里面的结石。手术效果良好,患者可以出院回家,再无其他不适。这一罕见病例无法归入现有的米利兹综合征分类。这个病例是否可以归类为米里兹综合征的另一种变异型或新类型?根据Mc.Sherry、Beltran或Csendes的分类法,本病例可归入米利齐综合征I-a型。结论:在米利兹综合征中,胆总管梗阻不仅是由远端胆囊管中的结石直接引起的,也可能是由胆囊管扩大引起的。这种类型的胆管梗阻以前从未报道过,因此这种罕见病例不能归入现有的米利兹综合征分类中。对于外科医生来说,今后识别类似病例非常重要,因为对胆管梗阻影像学检查结果的误解会给手术带来困难,并对患者造成伤害。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Compression of Common Hepatic Duct (CHD) Caused by Dilated Cystic Duct, is it Another Variant or New Type of Mirizzi Syndrome: A Case Report
Background : Narrowing or obstructing of Common Bile Duct (CBD) by gallstone impacted in distal cystic duct is known as Mirizzi Syndrome (MS). However, the compression of Common Hepatic Duct (CHD) because of the enlargement of cystic duct due to the impacted stone in the distal cystic duct has never been reported. Case Report: A 60 year old man, Indonesian Javanese ethnicity, came to the hospital with bile duct stone and obstructive jaundice due to the compression of Common Hepatic Duct (CHD) because of the enlargement of cystic duct. In this case, the stone just lies in the tip of the cystic duct causing obstruction of cystic duct but the stone does not directly compress the CBD. Long cystic duct with mid or low insertion into CBD possibly occurs in this case. The diagnosis of this case is common hepatic duct obstruction caused by the enlargement of cystic duct. Two surgeries were performed, the first surgery was only cholecystectomy, and the second surgery was taking out the remnant of cystic duct including the stone inside. The outcome of the surgery was good, and the patient was allowed to go home from the hospital without further complaints. This rare case cannot be grouped into the existing classification of Mirizzi syndrome. May this case be grouped as another variant or a new type of Mirizzi Syndrome ? This case could be grouped as type I-a of Mirizzi syndrome according to the classification of Mc. Sherry, Beltran or Csendes. Conclusion : In Mirizzi syndrome the obstruction of CBD is not only caused directly by the stone in distal cystic duct, but also it can be caused by the enlargement of the cystic duct. This type of bile duct obstruction has never been reported before and this rare case cannot be grouped into the existing classification of Mirizzi syndrome. It is important for surgeons to recognize similar cases in the future, misinterpretation of imaging findings of bile duct obstruction makes surgery difficult and harmful for the patient.
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来源期刊
Pharmacognosy Journal
Pharmacognosy Journal Pharmacology, Toxicology and Pharmaceutics-Pharmacology
CiteScore
2.20
自引率
0.00%
发文量
151
期刊介绍: In 2004, as the PHCOG.NET – a non-profit private organization dedicated to Natural Products Research leading to develop promising drugs. Our main mission is to make information on herbal drug research readily available in different formats to suit the individual needs. Pharmacognosy Journal (Phcog J.) is one of the six journals published by Phcog.Net, Each issue covers different topics in natural product drug discovery, and also publishes manuscripts that describe pharmacognostic investigations, evaluation reports, methods, techniques and applications of all forms of medicinal plant research
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