Modern diagnostic methods and approaches to the surgical treatment of Mirizzi syndrome
Keywords:syndrome, retrograde cholangiopancreatography, magnetic resonance imaging
Materials and methods. The work is based on the analysis of the case histories and clinical observations of 75 patients with chronic obstructive pulmonary disease complicated by Mirizzi syndrome. The paper uses the McSherry classification (1982). For the diagnosis, a set of modern methods was used: ultrasound, computer or magnetic resonance imaging, endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography. That allowed to establish the exact diagnosis and type of Mirizzi syndrome in 68–75 % of patients before the operation, in other cases, the diagnosis was made intraoperatively. Results. With ultrasound, Mirizzi syndrome was diagnosed in 22 (29.3 %) patients. The diagnostic sensitivity when detecting Mirizzi syndrome was 17.6 %. The standard for pre-operative diagnosis of Mirizzi syndrome is the methods of direct imaging of the bile ducts. Among them, endoscopic retrograde cholangiopancreatography is used most often. Diagnostic sensitivity of endoscopic retrograde cholangiopancreatography in the detection of Mirizzi syndrome was 75.0 %. Other methods of direct imaging of the bile ducts are considered as less relevant in the diagnosis of Mirizzi syndrome due to higher invasiveness. Spiral computed tomography and magnetic resonance cholangiopancreatography are diagnostic methods, whose specificity and accuracy are 93 and 98 %, respectively. In the presence of narrowing of the bile duct, in 25 (33.3 %) cases, Mirizzi syndrome I type was established, the volume of the operation was laparoscopic cholecystectomy. There was no mortality in this group. In Mirizzi syndrome type II, 47 (62.7 %) patients underwent an open cholecystectomy with plasty of the common bile duct on drainage. Mortality rate was 5.9 %. Conclusions. The study of anamnesis, clinical and laboratory data does not provide an opportunity to establish a diagnosis. Magnetic resonance imaging and endoscopic retrograde cholangiopancreatography are the methods with a high diagnostic sensitivity of 75 and 95 %, respectively. Surgical intervention is a radical method of treating patients with Mirizzi syndrome.
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