Mirizzi syndrome: whakarōpū, te tātaritanga, maimoatanga

Ko te ingoa "Mirizzi syndrome" e pā ana ki te ingoa o te tākuta i Argentina Mirizzi, e ko te kaituhi o maha mahi e pā ana ki te whaiaroaro o te excretion biliary, me te mahi haumanu i te mara o te cholegraphy intraoperative.

I roto i te 1948, whakaahuatia tona rata pūtaiao mahi semiotics radiological syndrome ate, tohu o nei puta stasis ate kanapa, me te contracture o te tau mahani ate. Ano, te pikitia calculouse syndrome i te aroaro, faaite nei i roto i te ahua o te fistula i waenganui i te gallbladder me hepaticocholedochus.

He he he totohe

Ko te mōhio ki tenei mate rite Mirizzi syndrome Ehara i te katoa. He aha te mea te reira, whakaahua tatou i raro. Otiia tuatahi ko reira ia tapao e pera tawhiti i roto i te rongoā e kore te tino tautuhi ariā rawa. Hei tauira, he tokomaha kaiwhakaako whakapono e te pūtake o te mate ko te whāiti o te lumen i te aerodynamics o te ate. syndrome waihanga nuinga whakawhānui tā te tāututanga o te mate ate me te wāhi stenosis tau mahani pute Hartmann tuanaki ranei, haere tahi nei i mumura o te tōngāmimi kawa me faaite ake i roto i te cholangitis mara jaundice ranei.

Mirizzi syndrome, tona whakarōpū te aroaro i roto i tenei tuhinga, ko te whakaaro o pūtaiao maha, āhuatanga te kore anake whāiti o te lumen. Ko te tukanga pathological whai wāhi tika tau mahani ate noa, me te noa.

Tino rerekē hamani te syndrome o kaipūtaiao e whakapono e te pūtake o te mate, ko te fistula puzyrnoholedohealny. He ātete whakaaro i runga i te localization o te tukanga pathological. I roto i te tahi mau tuhinga pūtaiao tuku ki whanaunga wāhi i waenganui i te gallbladder me te tau mahani ate noa, a i roto i te tahi atu pepa rangahau he tauira o wātea fistula i waenganui i te tōngāmimi au me te tau mahani ate noa.

Hei tauira, i roto i te whakarōpū o MV Corlette, H. bismuth (1975) kanohi fistula bilio-biliary rua ngā momo i runga i te localization o te huinga (i runga ranei i raro i te pūhui matua o te tau mahani whēwhē me kawa) rānei.

Ētahi kairangahau ahua te whakakitenga o te mate ki te whāiti o te lumen me fistula holetsistoholedohealnogo te hanganga hepaticocholedochus.

Rerekē tikanga tino fakafaingata'a'ia'i syndrome te tirohanga o tona ngako me te taimaha kitea tikanga whai hua ki te hamani i te reira.

I roto i nga tau tata nei, maha e taea e koe te kitea te tikanga hou o tenei māuiuitanga rite Mirizzi syndrome? Types E whakaaturia ona rua rerekē o te mate:

• puka whakapeka, i roto i nei te lumen hepaticocholedochus whāiti;
• puka ma'i, e whakaoho te ahua o te fistula i waenganui hepaticocholedochus me lumen gallbladder.

Te whakamārama puāwaitanga

Ko te whakamārama matarohia o te tukanga mate rite Mirizzi syndrome, he whakaahua o i te aroaro o te i roto i tenei pepa ngā o wha tikanga matua:

• tūranga tata mahani whakarara o te gallbladder me te ate o te tau mahani matua;
• Ko te aroaro o kohatu i roto i te gallbladder mahani ranei i tona kaki;
• taunutia rere tukanga ate, meinga nei i roto i te tau mahani me gallbladder mumura concrement whakaritea a tawhio reira;
• te aroaro o te jaundice ki waho ranei cholangitis ia.

te mau parau tumu o te whakarōpūtanga

He aha momo o tenei mate wehea te rite Mirizzi syndrome? Te whakarōpū tā te taumata whakangaromanga o te ate puzyrnoholedohealnym taiepa mahani fistula matua (Csendes):

• Patohia ahau - pēpēhinga nga kohatu tau mahani kaki ate gallbladder noa tau mahani ranei.
• Momo II - aroaro o fistula vesico-holedohealnogo noho iti iho i te 1/3 o te katoa paenga o te tau mahani o te ate;
• Momo III - aroaro o fistula vesico-holedohealnogo, e noho 2/3 o te paenga o te tau mahani o te ate;
• Momo IV - aroaro o fistula vesico-holedohealnogo, e e paenga tonu tau mahani ate, i raro ai te te taiepa mahani ki te whakaoti i te whakangaromanga.

Take o te whanaketanga syndrome

Ko te take matua o tenei mate rite Mirizzi syndrome e:

• kōpeketanga lumen ate tau mahani waho i whakapataritari cholecystitis calculous whakapeka;
• aroaro o te stricture ate tau mahani kei waho te rohe o te ate;
• hepaticocholedochus hanganga o ngā pūwatawata i te aroaro o te stricture;
• whanaketanga o te whakakorenga whakarara fistula vesicovaginal holedohealnogo o stricture.

Tei runga i te hanganga o aerodynamics biliary, kia whakatārewatia te rahi me te taimaha o kohatu, me te tikanga o te tukanga maimoatanga i tetahi o nga kaupae i runga, engari e taea te kitea i te tauiraa i te kōpeketanga iti o te tau mahani ate i roto i te fistula vesico-holedohealny anake i mate gallstone.

manahune Kōpeketanga ki ate tau mahani stricture ki te roa pokanga te ka riro i te mate puka ma'i, i roto i nei whakakapia te wā o te murunga te tae rawa. A, no te haamata i te wa o te taiepa gallbladder me hepaticocholedochus whakapā e rongo i tetahi kohatu nui i roto i te pute o Hartmann. I raro i te pēhanga o tona taimaha taumaha trophism whakatika taiepa decubitus gallbladder me te tau mahani. Na ka hanga e fistula puzyrnoholedohealny te.

Na roto o te taua pūrongo pathological i te gallbladder ki te lumen hepaticocholedochus concretions hinga. nui haere Fistula i roto i te whānui mā te whakaiti i tona rohe kiko kōpeketanga. Ka rite ki te hua, tonu, heke te whāiti o te wahi proximal o hepaticocholedochus ko te gallbladder i roto i te rahi, riro te reira kaki, pute Hartmann me te wahi nui o te tinana. Ka rite ki te hua, riro te gallbladder rite divertikulopodobnoe mātauranga, i te mea he karere ki te lumen o tau mahani ate extrahepatic te whakamahi i te anastomosis whānui. Ka rite ki te tikanga, kahore he rere mirumiru.

tohutanga

Nahea Mirizzi syndrome? Tohu āhuatanga o te cholecystitis puta i roto i te puka whakapeka ma'i ranei ki te whanaketanga o te jaundice aunoa. Ko te maha nui o tūroro i roto i nga pitopito kōrero hauora atu ngā mate gallstone ki whakaeke auau, huritaiāwhio jaundice aunoa. Mō raraunga pūtaiao, te kānapanapa me te nuinga o tohumate maha whakakitea ngā mamae i roto i te puku tika o runga. jaundice mamae me te āwangawanga i roto i te 60-100% o te wā.

puta maha jaundice i te aroaro o te fistula vesico-holedohealnogo.
A, no te cholangitis tuhia kirika. I te tahi taime whakakorikoria mamae i roto i te hypochondrium, haurangi, te whanaketanga o te pancreatitis (mahi hei whakakikorua i runga i te mate noa). I roto i te toto whakanuia ana te auau o bilirubin, ALT, AST, me kawakore phosphatase.

Ko wai te mea atu noa?

Puta Mirizzi syndrome i 0.1% o tūroro ki te aroaro o te mate gallstone. Ki te kite wawaotanga hāparapara i roto i 0.7-2.5% o tūroro. Mate, e rua nga tangata me nga wahine tino iwi me te iwi katoa. I roto i te tau tawhito, puta nui atu pinepine mate.

tikanga o te tātaritanga

He aha te mea te matatini o te maimoatanga o taua mate rite Mirizzi syndrome? e kore te tino tautuhi tātaritanga me te huarahi hāparapara.

I roto i te rongoā hou, kahore he ture whänui ana te whakaaetia mō te whakahaere ngā tukanga tātaritanga. Ahakoa te ahunga whakamua i roto i te mara o te whakaahua hauora tini o nga mate, whakaturia te mahi tātaritanga kua ake ki uaua. Tenei mahi e pā ana ki te 20% o te wā. Anake kua tuhia he torutoru kairangahau e ultrasound o te mate i mua i te mahi tae te ūnga pū o 67,1% o te wā, MRI - i roto i te 94,4%, ultrasound intraductal - i 97%, me te endoscopic cholangiopancreatography retrograde - 100%.

Katoa o tenei fokotu'u e kore e hanga tonu tikanga hou o te tātaritanga mauhaa reira taea ki te tāutu i Mirrizi syndrome i roto i te wā mua i te mahi.

Nuinga o ngā wā, i kitea, no te ultrasound te tohu e whai ake nei:

• tau mahani toronga i roto i te ate me te tona whakarara ineine proximal ki te tau mahani noa gallbladder unexpanded;
• te kimi gallbladder mingimingi kāwanatanga.

hāngai CT Mirizzi tohu syndrome ki te āhuatanga kitea e te ultrasound. Ahakoa kore e taea e CT whakarato mōhiohio tāpiri nui ki te tikanga ultrasonic, tona tūranga i roto i te whakatau i te aroaro o te mate pukupuku i te aerodynamics proximal o te gallbladder ko kaua tiketike, i te mea nui i roto i te pārōnaki Mirrizi syndrome ki te aroaro o te mate pukupuku.

atahanga te kōwarotanga autō, endoscopy me cholangiopancreatography retrograde (ERPHG) tikanga tātaritanga e ōrite i roto i te whakaaro ki te tāutu me te stricture holetsistoholedohealnogo fistula. Ko te whakaahua i roto i te T1 aratau me T2 taea e atu tika te wehe mumura i mate pukupuku, e kore te mea te reira tonu he CT peu maitai me te ultrasound. Heoi, e tika ana ki te utu nui o te whakamātautau e MRI tenei tikanga tātaritanga kore e tono i roto i te pokapū hauora katoa.

cholangiopancreatography te kōwarotanga autō ko te momo āhua hou, engari iti ako o te tātaritanga. tiro maha ngā pūtaiao reira rite he whakaaro tino whaihua ki te tautapa taua māuiuitanga rite Mirrizi syndrome.

Ētahi pūtaiao mea i roto i to ratou tuhituhi nga painga o te ultrasonography laparoscopic rohe pancreatoduodenal. I roto i te pokanga mō te tātaritanga whakapae o CM tenei tikanga hanga reira taea ki te hanga i te whakapakoko wā-tūturu o te aerodynamics ate i roto i te maha rererangi hua o koki rerekē. I tēnei wā, Heoi, e noho uaua, me te unexplored tae noa te mutunga tenei tikanga.

Me kï reira e, ahakoa te oraraa o tikanga rerekē o te tātaritanga, whakapumautia he tino uaua tonu te aroaro o te CM, e taea te whakauru i te taote kotiti, ka meinga kino ki te tau mahani ate noa, e i mohio a hape rite te tōngāmimi au he rere whānui ranei. Kei te e aki ana ki te whakawhanake i te ara pai te kore o ngā tikanga whänui ana te whakaaetia o te tātaritanga i mua i pokanga.

Aratohu maimoatanga

Kia pehea te to'o Mirizzi syndrome? Treatment whai wāhi e rua ngā wāhi matua: tikanga rentgenoendoskopichesky me wawaotanga hāparapara.

Ka taea te tono momo Rentgenoendoskopichesky o maimoatanga rite te taahiraa tuatahi i mua ki te pokanga i roto i te faaineineraa no te pokanga. mahi ia hei tikanga motuhake o te maimoatanga o te tūroro ki te aroaro o SM i te take o te tūpono whakarehu tiketike.

Ko te huakore REV maha kairangahau ngā:

• radiation te rongo ki tūroro me ngā kaimahi hauora;
• utu nui mō te endoscopy me X-ray whakamātautau;
• te ngoikore ki te whakakore i te whāiti o te lumen o wahi proximal o te tau mahani ate noa.

E ai ki te tuhinga pūtaiao rerekē nui i roto ia ratou ara o te wawaotanga mahi. He kōwhiringa ngā mō ngā mahi hāparapara i SM.
Ētahi tākuta whakapono e Mirrizi tukinotia e te syndrome laparoscopy te tino contraindicated.

E te puka ake noa o mahi ka te momo tuatahi he cholecystectomy syndrome, tāpiri nei e riringi choledoch.

Kia pehea te manaaki i te taha o te aroaro o te fistula biliobiliarnogo Mirizzi syndrome? titau mahi-a wehenga me te whakaora hloledoha tapatahi. Ka rite tetahi o nga ara o te kati i te tau mahani ate noa, tono nei i te nuinga o tākuta ko ki te whakakore i te koha o tona taiepa i roto i mahue tetahi wahi o te au tōngāmimi. Heoi, e whakapono etahi kaiwhakaako e mahue i te kikokiko e taea te whakanui ake i te mōrea o te choledocholithiasis wäriu.

I roto i te aroaro o te fistula holetsistobiliarnogo tūtohutia te whakatinanatanga o te noa stents ate tau mahani kirihou i runga i te āhua rangitahi. Ko te hiahia hoki tenei momo o te mahi maha pūtaiao, whakamārama i te aroaro o huringa wā roa-tupu i roto i te rohe o te natura inflammatory mea tuhonohono e hepatoduodenal, e taea te mohio a ai te SM rite tauira kino taiepa ate tau mahani. I to ratou deformation ate taiepa mahani nui ngā i roto i te fistula.
I roto i te pokanga, i reira te mea he taumata tiketike o te mōrea o pōauautanga.

pōauautanga taea

Nuinga o ngā wā puta reira i muri i te pokanga ko te pōauautanga rite ate noa tau mahani stricture. E ai ki te kairangahau Russian Gi Dryazhenkova (2009) o te 46 tūroro e Nōna ka pokanga, puta stricture i roto i 6.5%.

He aha ngā hua o ngā mahi i runga i te pana wai ngaro pera-ka karanga, i hanga wha tūroro ki te puka CM tuatahi (view stenotic)? Kairangahau V. S. Savelev, VI Revyakin (2003) tuhia nga akiaki pai o te mate, Heoi, te whakamārama i te tango o te rohe tau mahani o te pūnaha waikeri ki te take e whai ake nei:

• whanaketanga o te jaundice;
• i whakapataritari pana wai arai te hanganga o te calculi iti;
• waipara Mariao i runga i nga taiepa o te waikeri;
• haaputuputuraa o te detritus, rite i roto i te ōritetanga ki te putty e whakaoho patua recurrent o cholangitis.

Ko te tohu teitei o te uaua o te mahi i runga i te tūroro ki te tohu nui o te whakangaromanga taiepa tau mahani ate noa. Ki te ko te mate i roto i te toru ranei te wha o nga atamira, kua tuhia reira he auau te tahuti teitei i muri i te pokanga. A, no te kei te mate i roto i te toru ranei te wha o nga taumata, te nuinga o tākuta paingia te holedohoeyunoanastomoza.

Treatment i muri i te pokanga

Ka rite ki tāmau syndrome Mirizzi? Treatment i muri i te pokanga tā tuku tatau toto te aonga ake i muri i te mahi, kotahi wiki, me te kotahi ra i mua i rere i te hōhipera. E nekehia atu Sutures i te ra 10.

Ko te roa toharite o te hōhipera noho ko 10-12 ra. Ko te katoa roanga o te wā whakaora ko rua nga marama.
Tikanga, whakakitea tūroro okiokinga i roto i te hōhipera i roto i te tari whakanohonoho.

mutunga

Ki te rā Mirizzi syndrome, whakarōpū, te tātaritanga me te maimoatanga o e whakaahuatia i roto i tenei tuhinga, i titiro rongoa te rite tetahi o nga pōauautanga o te mate gallstone. Heoi, i roto i te mara o te tātaritanga me te pokanga ko tonu he maha o ngā take kāore anō.

Ahakoa te meka i reira ko te whānuitanga o ngā momo rerekē o te wawaotanga hāparapara ngā, e kore e whakatau tonu hua maimoatanga te tūmanakohia.
I roto i te mahi, nui haere auau pōauautanga te pütahitanga, me te postoperative.

Uauatanga i roto i te whakahaere ngā mahi tātaritanga, te mōrea o te kino o te tau mahani ate, te maha iti o ngā kitenga, me te hihinga o tikanga o pokanga taonga ko te tikanga matua mo ake i roto i-hohonu ako o te raruraru.

Ko te kupu whakataki o te mau parau tumu hou o tātaritanga me te whanaketanga o founga tino arotau i roto i te mara o te pokanga i runga i te atamira o te mate e āhei manawanui ki te arotau i therapy ki tenei pōauautanga o cholelithiasis.