Mirizzi 증후군의 임상적 고찰

Abstract

Background/Aims: The Mirizzi syndrome, which occurs in 0.7-l.4% of patients undergoing cholecystectomy, is an unusual benign obstruction of common hepatic duct resulting from extrinsic compression by a gallstone impacted in either the neck of the gallbladder or the cystic duct. The aim of this study is to investigate the clinical features of Mirizzi syndrome. Methods: From January 1989 to April 1998, among 1,320 patients with gallstone disease, 17 patients were diagnosed as having Mirizzi syndrome at Severance Hospital. Their medical records were reviewed and their clinical, radiological, and surgical features were analysed retrospectively. Results: l. The incidence of Mirizzi syndrome was 1.3% (17/1320). Included patients comprised of 12 males and 5 females, with an average age of 59.0 years (range 3-86). 2. The presenting symptoms were right upper quadrant pain 11 (64.7%), followed by jaundice 9 (52.9%), indigestion 7 (41.2%), nausea 6 (35.3%), fever 2 (11.8%), and pruritus 2 (11.8%). 3. According to the Csendes’ classification, the cases were categorized into type I 12 cases (70.5%), type II 1 case (5.9%), type III 2 cases (11.8%), and type IV 2 cases (11.8%). 4. Open cholecystectomy was applied to nine patients. Three patients who were believed to be unfit for surgery because of high risk were treated by endoscopic approach. There was no procedure-related complication. Conclusion: The Mirizzi syndrome is an unusual complication of gallstone disease. Though accurate diagnosis and cholecystectomy is a rational option, medical treatment can be performed in selected patients who are unfit for surgery.