Mirizzi syndrome: soocidda, cudurka, daaweynta

Magaca "Mirizzi syndrome" la xidhiidha magaca dhakhtar qalliin oo ka soo Argentina Mirizzi, waa kii qoraaga shuqullo badan oo la xiriira jirka reer Digo biliary, iyo sidoo kale nidaamka bukaan eegida berrinkii cholegraphy intraoperative.

In 1948, uu dhakhtar shaqada sayniska ku tilmaamay semiotics shucaaca cagaarshowga syndrome, calaamadaha, taas oo u muuqatay Stasis bile dhalaalaya iyo contracture of koollo bile ah. Sidoo kale, sawirka calculouse syndrome ayaa lagu soo bandhigay, kaas oo lagu muujiyay in muuqaalka kore ee fistula u dhexeeya kaadi haysta iyo hepaticocholedochus.

Waxaa jira khilaaf ah

Ma aha qof kasta waa la yaqaan cudurkan sida Mirizzi syndrome. Waa maxay, waxaan hoos ku tilmaami. Laakiin marka hore waxaa xusid mudan in ilaa iyo haatan in daawo fikradda aad aan si buuxda u qeexan. Tusaale ahaan, dhakhaatiir badan waxay aaminsan yihiin in ku saleysan cudurka waa meel cidhiidhi ah Lumen ee marinnada beerka. Inta badan balaariyay dejinta syndrome ku lug leedahay aqoonsiga cudurka beerka la koollo aagga stenosis ama jeebka Hartmann kalkulas, kaas oo la Ulasocto barar ah xameetida iyo muuqato in cholangitis beerta ama cagaarshow.

Mirizzi syndrome, kuwaas oo kala soocidda la soo bandhigay ee qodobkan waa fikrad ah ee saynisyahano badan, waxa lagu gartaa gaabiso of Lumen ma aha oo kaliya. Geedi socodka bahal ku lug koollo caadi ah iyo xaq u bile.

Absolutely duwan ula dhaqmaan syndrome ee saynisyahano kuwaas oo aaminsan in ku saleysan cudurka fistula waa puzyrnoholedohealny. Waxaa jira views soo horjeeda on deegaamaynta ah ee hanaanka bahal ah. In qaar ka mid ah articles sayniska gudbiyo xiriirka meel u dhaxaysa kaadi haysta iyo koollo guud cagaarshowga, iyo waraaqaha kale ee cilmi-baarista waxaa ku qoran tusaalooyinka fistula helitaanka dhexeeya xameetida iyo koollo bile caadi ah.

Tusaale ahaan, in kala soocidda ee MV Corlette, H. bismuth (1975) wakiil fistula bilio-biliary laba nooc oo ku xiran deegaamaynta ah ee kulanka (sareeya ama ka hooseeya xarunta ugu weyn ee koollo ah fibrosis iyo xammeeti).

Qaar ka mid ah cilmi-u yeelaan muujinta cudurka si cidhiidhi ah ee Lumen iyo dhismaha hepaticocholedochus fistula holetsistoholedohealnogo.

fasiraad kala duwan muhiimad syndrome adkaynaysaa aragtida ah in ay nuxurka iyo culus ka heli habab wax ku ool ah loo daaweeyo.

Sanadihii la soo dhaafay, inta badan waxaad ka heli kartaa fasiraadda cusub ee cudurada sida Mirizzi syndrome? Noocyada oo dhanba waxaa lagu muujiyey laba Lahjadaha cudurka:

• foomka ba'an, taas oo ah Lumen hepaticocholedochus cidhiidhi ah;
• foomka chronic, oo dhirfinaya muuqaalka kore ee fistula u dhexeeya hepaticocholedochus iyo Lumen kaadi haysta.

Tilmaanta classical

Sharaxaad The classic of nidaamka cudurada sida Mirizzi syndrome, sawir ah kaas oo la soo bandhigay warqad this ka kooban yahay afar qodobada ugu muhiimsan:

• meel u dhow koollo isku midka ah oo ka mid ah kaadi haysta iyo beerka ee koollo ugu weyn;
• Joogitaanka dhagaxyo oo kaadi haysta ama koollo in qoortuu u sudhay;
• socodka nidaamka beerka obstructive, kaas oo sababay in koolada iyo kaadi haysta concrement caabuq go'an oo ku wareegsan;
• joogitaanka joonis leh ama aan lahayn cholangitis isaga.

mabaadii'da kala soocidda

Waa maxay noocyada kala duwan ee cudurkan waxa loo kala qaybiyaa sida Mirizzi syndrome? kala soocidda waxay ku lug leedahay heerka burburinta derbiga koollo fistula ah puzyrnoholedohealnym beerka ugu weyn (Csendes):

• Waxaan Nooca - Tuujiya dhagaxyo koollo kaadi guud beerka qoorta ama koollo.
• Nooca II - joogitaanka of fistula vesico-holedohealnogo degan ka yar 1/3 of goobada guud ee koollo beerka ku yiil;
• Nooca III - joogitaanka of fistula vesico-holedohealnogo, kaas oo degan 2/3 of goobada ee koollo beerka ku yiil;
• Nooca IV - joogitaanka of fistula vesico-holedohealnogo, taas oo qaadataa goobada buuxa koollo cagaarshowga, kuna waari dhexdeeda derbiga koollo la sakhiray si ay u dhamaystiraan burburinta.

Sababaha horumarka syndrome ah

Sababaha ugu waaweyn ee cudurka this sida Mirizzi syndrome waa:

• riixo Lumen koollo bile dibadda xanaajiyeen cholecystitis calculous ba'an;
• joogitaanka of stricture koollo bile ku yaal meel ka baxsan gobolka beerka;
• formation of hepaticocholedochus perforations in joogitaanka stricture;
• horumarinta fistula vesicovaginal holedohealnogo reebay isku midka ah ee stricture.

Iyadoo ku xiran qaab-dhismeedka marinnada biliary, xajmiga iyo miisaanka oo dhagaxyo ah, iyo sidoo kale hababka nidaamka daaweynta waa la hakin kara in mid ka mid ah tallaabooyinka ku xusan, laakiin isbedelka ka soo riixo yar oo koollo bile ee fistula vesico-holedohealny la ogaan karaa oo kaliya at cudurka sii qorsheysnaa.

Riixo degenerates galay bile duct stricture haddii qalliin dib loo dhigo cudurka uu noqdo qaab raaga, taas oo muddada dembidhaafka waxaa bedelay kahadlay. Marka markii derbiga kaadi haysta iyo hepaticocholedochus bilaabaan xiriir sababay dhagax weyn ee jeebka ee Hartmann. Under cadaadiska uu miisaanka trophism sii xumaanaya baxdo derbiga kaadi decubitus iyo duct. Markaas fistula puzyrnoholedohealny waxaa la aasaasay.

Iyada oo la adeegsanayo sida a wararka bahal ka kaadi ah gelin Lumen hepaticocholedochus concretions dayrta. Fistula kordhay dhexroor by yaraynta ay zone riixo unugyada. Sidaas darteed, cidhiidhi ee qaybta proximal of hepaticocholedochus sii socoto, kaadi haysta waa la dhimay ee size, waxaa baaba'aa qoorta, jeebka Hartmann iyo qayb weyn oo ka mid ah jidhka. Sidaas darteed, kaadi haysta uu noqdo sida waxbarashada divertikulopodobnoe, taas oo ah fariin la Lumen ee koollo bile extrahepatic isticmaalaya anastomosis ballaaran. Sida caadiga ah, ma jiraan wax socodka xumbo.

symptomatology

Sidee Mirizzi syndrome? Astaamaha caan ku cholecystitis dhacdaa qaab daran ama joogtada leh horumarinta joonis farsamo. Tirada badan ee dadka bukaanka ah ee qoraalada caafimaad oo dheeraad ah ee jira cudurka qorsheysnaa la weeraro joogta ah, cagaarshow farsamo meerto. About xogta sayniska, ugu ifka badan oo intooda badan calaamadahaasi waxay inta badan ku muujiyey waxaa ka mid ah xanuun caloosha midig sare. Xanuun iyo jaundice ka walaacsan in 60-100% ee kiisaska.

Cagaarshow u muuqataa inta badan ay goobjoog ka ahaayeen fistula vesico-holedohealnogo.
Marka cholangitis xusay qandho. Mararka qaarkood rabshin xanuun hypochondrium, sarkhaan, horumarinta ganaca (falimihiisii kale sida ku dahaadhaa ku cudur caadi ah). In dhiigga kordhiyaa heerka of bilirubin, ALT, AST, iyo phosphatase xumadoodu.

Yaa ku badan yahay?

Mirizzi syndrome dhacdaa 0.1% bukaannada qaba jiritaanka cudur sii qorsheysnaa. Haddii qalliin lagu arkay 0.7-2.5% bukaannada. Buka, labadaba rag iyo dumar gabi ahaanba jinsi kasta iyo quruumaha. In da 'weyn, cudurka dhacdaa ka badan ayaa si joogto ah.

hababka ogaanshaha

Waa maxay caqabadaha daawaynta cudurada sida Mirizzi syndrome? Cilad-iyo hab qalliin si buuxda ma loo qeexay.

In daawada casriga ah, ma jiraan wax xeerar guud ahaan aqbalay ee samaynta nidaamka lagu ogaanayo. In kasta oo horumar ah oo duurka ku ah caafimaadka imaging cudurro kala duwan, hawlgalka cudurka la qotomiyey ku adag tahay. Tani waxay ka shaqeeya oo ku saabsan 20% ka mid ah xaaladaha. Kaliya cilmi yar ayaa xusay ultrasound in cudurka ka hor qaliinka gaaro bartilmaameedka saxda ah 67,1% ee kiisaska, MRI - in 94,4%, ultrasound intraductal - at 97% iyo joogayso retrograde endoscopic - 100%.

All of this soo jeedisay in hababka casriga ah ee cudurka xarkaha mar walba ma samaysaa suuragal ah in lagu Mirrizi syndrome in muddo la soo dhaafay hawlgalka.

Inta badan, marka ultrasound helay calaamadaha soo socda:

• koollo kordhin gudahood beerka iyo sidoo kale ay barbar tuuray proximal inay kaadi unexpanded koollo caadi ah;
• helidda kaadi waanuu gobolka.

Tilmaamayaasha syndrome CT Mirizzi beego sifooyinka la ogaado by ultrasound. Inkastoo CT aan ku siin kara macluumaad dheeriga muhiim ah in habka Xiinka, doorkeeda go'aaminta joogitaanka kansarka in marinnada proximal khalkhalka waa halkii sare, taas oo muhiim ah in kaladuwan ee Mirrizi syndrome la joogitaanka kansarka.

imaging resonance magnetic, endoscopy iyo joogayso retrograde (ERPHG) hababka ogaanshaha waa u dhiganta ku saabsan garashada iyo fistula holetsistoholedohealnogo stricture. sawiro ee T1 hab iyo T2 noqon karaa mid sax ah kansarka kala saaro barar, ma aha had iyo jeer CT Samo falku inaad ah oo ultrasound. Si kastaba ha ahaatee, ay sabab u tahay qiimaha sare ee imtixaanka by MRI habkan ogaanshaha aan codsatay in dhammaan xarumaha caafimaadka.

joogayso resonance magnetic waa nooc cusub, laakiin wax yar ka bartay of diagnosis. Dhowr saynisyahano u arkaan inay arrintaashi tahay views ugu wanaagsan si loogu magacaabo cudurada sida Mirrizi syndrome.

saynisyahano Qaar waxay yidhaahdaan in ay qoraallada faa'iidooyinka aagga pancreatoduodenal ultrasonography laparoscopic. Inta lagu jiro qaliinka cudurka looga shakisan yahay CM habkan waxay suuro gelineysaa in la dhiso a image-waqtiga dhabta ah ee laga shido bile ee dhowr diyaaradood oo midho xaglaha kala duwan. Currently, si kastaba ha ahaatee, habkan weli karin iyo awoodo aan ilaa iyo dhamaadka.

Waa in la ogaadaa in, inkastoo jiritaanka hababka kala duwan ee cudurka, dhiso joogitaanka CM weli waa mid aad u adag, taas oo soo saari kartaa dhakhtar qalliin oo dhumiyey oo ku keenin dhaawac koollo u bile caadi ah, kaas oo si qalad ah loo arko xameetida ama socodka ballaaran. la'aanta ah ee hababka guud ahaan aqbalay of diagnosis qalliinka ka hor waxaa riixaya si ay u horumariyaan hababka ugu fiican.

Tilmaamaha daweynta

Sidee reebay Mirizzi syndrome? Daaweynta ku lug leedahay laba qaybood oo waaweyn: Habka rentgenoendoskopichesky iyo qalliin.

nooca Rentgenoendoskopichesky daaweynta lagu saleyn karaa tallaabo hore ka hor inta aan qaliin loogu diyaar qaliin. Waxa uu u dhaqmo sida hab madax banaan oo ka mid ah daaweynta bukaannada qaba joogitaanka SM in ay dhacdo khatar sare suuxinta.

darrada The Rev cilmi badan oo ka mid ah:

• gaadhista shucaaca bukaanka iyo shaqaalaha caafimaadka,
• qiimaha sare ee endoscopy iyo X-ray baaritaanka;
• awood la'aanta in la baabi'iyo cidhiidhi ee Lumen ee qayb proximal of koollo u bile caadi ah.

Sida laga soo xigtay suugaanta sayniska si weyn isu jidadka qabashada qalliinka ka mid ah way kala duwan yihiin. Waxaa jira fursado kala duwan oo qalliin ah ee SM.
dhakhaatiirta Qaar ka mid ah waxay aaminsan yihiin in Mirrizi loola dhaqmo by laparoscopy syndrome waxaa gabi ahaan uu u.

By foomka badan ee hawlgalka marka nooca ugu horeysay ee waa cholecystectomy syndrome, kaas oo kaabaya dheecaan ka choledoch.

Sidee u gargaartay by joogitaanka fistula ah biliobiliarnogo Mirizzi syndrome? Hawsha xaaladeed u baahan tahay kala go'a iyo soo kabashada daacadnimada hloledoha. Sida mid ka mid ah jidadka ku dhow koollo u bile caadi ah, oo waxaa laga codsadaa aqlabiyad ah dhakhaatiirta qalliinka waa in la baabi'iyo iin ay derbiga iyada oo qayb ka hadhay xameetida. Si kastaba ha ahaatee, qaar ka mid ah dhakhaatiirta ay aaminsan yihiin in ka tago nudaha kordhin kartaa halista ah ee choledocholithiasis haraaga ah.

In joogitaanka fistula ah holetsistobiliarnogo talinayaa hirgelinta caadi ah balaastigga stents koollo bile on dabeecadda ku meel gaadh ah. Baahida loo qabo noocan ah hawlgalka, saynisyahano badan sharxi joogitaanka isbeddel muddo dheer ka dhacaya degaanka dabiiciga ah bararka seedaha hepatoduodenal, dheehan SM la arki karo derbiyada koollo bile dhaawac model. At ay badan derbiga koollo bile lahayo ku daro fistula ah.
Inta lagu jiro qaliinka, waxaa jira heer sare ah halista dhibaatooyinka.

dhibaatooyin ay suuragal tahay

Inta badan waxa ay dhacdaa ka dib markii qaliin waa dhibaatooyin sida bile duct caadi stricture. Sida laga soo xigtay cilmibaadhaha Ruush GI Dryazhenkova (2009) ee 46 bukaan qaliin maray, stricture dhacay 6.5%.

Waa maxay natiijooyinka hawlgallada on dheecaan waxa loogu yeero lumay, oo waxaa loo sameeyey afar bukaan oo qaba foomka bilowga ah CM (view stenotic)? Cilmi V. S. Savelev, VI Revyakin (2003) xusay isbedbeddelka wanaagsan ee cudurka, si kastaba ha ahaatee, u sharax ka saarida ee aagga koollo nidaamka bullaacadaha u sababaha soo socda:

• horumarinta jooniska,
• xirma dheecaan ka xanaajisay formation of calculi yar;
• dhigaalka cusbada on darbiyada dheecaan;
• raasamaal ee dhabkiyo, oo la mid ah in si joogta ah ay u Putty ah in dhirfinaya weerarada soo noq of cholangitis.

Heerka ugu sareeya ee ku adag tahay hawlgalka waa on bukaanka qaba Heer sare ah ee bile caadi burburinta derbiga duct. Haddii uu cudurku waa in marxaladda seddexaad ama afaraad, waxaa la ogaadaa heerka sare dhimashada qalitaanka ka dib. Marka uu cudurku waxa uu ku yaalaa ee heerka seddexaad ama afaraad, dhakhaatiirta qalliinka ugu naxa holedohoeyunoanastomoza ah.

Daaweynta qalliinka ka dib

Sida xirtay Mirizzi syndrome? Daaweynta qalliinka ka dib ku lug count dhiig dhiibaan maalinta ku xigta qalliinka kadib, hal todobaad oo hal maalin ka hor dheecaan ka isbitaalka. Tolay laga saaro maalinta 10aad.

oo dhererkeedu wuxuu celcelis ahaan joogtid isbitaalka waa 10-12 maalmood. Muddada guud ee muddo soo kabashada waa laba bilood.
Sida caadiga ah, bukaan tusay nasashada sanatorium ah in waaxda dayactirka.

gunaanad

Si aad u taariikhda Mirizzi syndrome, kala soocidda, baaritaanka iyo daawaynta kuwaas oo ku tilmaamay in this article, daawada waxaa loo arkaa mid ka mid ah dhibaatooyinka cudurka sii qorsheysnaa. Si kastaba ha ahaatee, berrinkii ogaanshaha iyo qalliinka weli waa arrimo dhowr ah oo aan la xalin.

In kasta oo xaqiiqda ah in uu jiro kala duwan oo noocyo kala duwan oo qalliin, natiijooyinka daaweynta had iyo jeer ma la kulmaan la filayo.
Inta uu hawlgalka socday, kordhiyay heerka dhibaato soonoolaysay postoperative.

Adkaata hawlo ogaanshaha, halista waxyeellada of koollo u bile, tirada yar ee indhaynta, iyo spectrum qani ku ah hababka qalliinka waa shardi u tahay more waxbarasho ee dhibaatada qoto-dheer.

hordhaca ah ee mabaadi'da casriga ah ee cudurka iyo horumarinta xeeladaha aan fiicnayn oo duurka ku qalliinka ku xiran marxaladda cudurka awood bukaanka in ay tayadoodii therapy leh dhibaato this of cholelithiasis.