Mirizzi maʻi pale: Mea Maluna,ʻike, lapaʻau

Ka inoa "Mirizzi maʻi pale" pili me ka inoa o ka surgeon mai Argentina Mirizzi, no ke kumu o na mea he nui i na hana e pili ana i ka physiology o biliary excretion, e like me lapaʻau hana maʻamau ma ke kula o intraoperative cholegraphy.

I ka 1948, me kona mau 'epekema hana kauka ho'ākāka' ia ma radiological semiotics hepatic maʻi pale, symptoms o ka iʻikeʻia huali bile stasis a me contracture o ka bile leki uea. Nō hoʻi, ke kiʻi calculouse maʻi pale i hōʻike, a ua hoikeia ma ka helehelena o ka fistula ma waena o ka gallbladder a me ka hepaticocholedochus.

Aia ka he hoopaapaa

'Aʻole i pau ka kama'āina i kēia maʻi like Mirizzi maʻi pale. He aha ka mea, ua hōʻike ma lalo nei. Akā mua ia ka waiwai 'ana i kumumanaʻo ana pela mamao ma ka lapaau loa manaʻo uaʻaʻole maopopo hoakaka. No ka laʻana, he nui loa na kumu manaoio i ke kumu o ka maʻi o ka hou o ka lumen i loko o nā ducts o ke akepaʻa. Loa hoʻonui hoʻomanaʻo maʻi pale komo ai i ka 'ike o ke akepaʻa maʻi me ka stenosis āpana leki uea' ole eke Hartmann calculus, i ua pu ma ka li nui o ka au bladder, a hoike mai ai ia ia iho i loko o ke kula cholangitis paha jaundice.

Mirizzi maʻi pale, kona Mea Maluna ua hōʻike i loko o keia 'atikala o ka manao o na mea he nuiʻepekema, ua wehewehe aku i wale hou o ka lumen. Ke pathological kaʻina komo ai pono, he pono ole, a he pono ole bile leki uea.

Loa okoa hana i ka maʻi pale o nā kānakaʻepekema ka poe i manaoio i ke kumu o ka maʻi i puzyrnoholedohealny fistula. Aia i kue manao ma ka IIeEeAIEUAA o ka pathological kaʻina. Ma kekahi 'epekema' atikala haawiia i wahi pili aloha ma waena o nā gallbladder, a me ka ho'ānoʻole hepatic leki uea, a me nā noiʻi pepa e examples o ka loaʻa nui fistula ma waena o ka laau awaawa, a me ka bladder, he pono ole bile leki uea.

No ka laʻana, ma o ka Mea Maluna o MV Corlette, H. Bismuth (1975) poe bilio-biliary fistula mau ano ke kaumaha ma muli o ka IIeEeAIEUAA o ka huina (ma luna paha ma lalo o ka papa kuhikuhiE hui o ka cystic leki uea a me ka laau awaawa,).

Kekahi mau noiʻi ke kaila o ka hoike ana mai o ka maʻi a hiki i ka hou ana o ka lumen a me ke kahua hepaticocholedochus holetsistoholedohealnogo fistula.

E lauwili anoʻano nui maʻi pale complicates ka pokole o kona o Mānoa, a kaumaha loaʻa ka hoʻokō kāu kiʻina hana e pono ia.

Ma nā makahiki, pinepine oe hiki ke 'imi i ka hou ka hoohalike ana o keia pathology like Mirizzi maʻi pale? Ano ona i hōʻikeʻelua Lolina o ka maʻi.

• huʻi palapala, i i ka hou lumen hepaticocholedochus;
• maʻi palapala, i ka hoʻonāukiukiʻana i keʻano o ka fistula ma waena o hepaticocholedochus a me gallbladder lumen.

Ka panina hōʻikeʻano

Ke Classic hōʻike o ka maʻi kaʻina hana like Mirizzi maʻi pale, he Hawaii photo no i ua hōʻike ma keia pepa oia o ka papa i ho'ākāka 'eha:

• kokoke kulana laua leki uea o ka gallbladder a me ke ake ana o ka papa kuhikuhiE leki uea;
• Ke alo aku o nā pōhaku i loko o ka gallbladder a leki uea i loko o kona ai;
• obstructive ake kaʻina pele, i ka mea i kauoha ia ma ka paa concrement leki uea a me ka li nui gallbladder a puni ia;
• i ke alo o ka jaundice me ka me ole cholangitis ia ia.

nā loina o ka Mea Maluna

He aha ano o keia maʻi ua maheleia me Mirizzi maʻi pale? Na Mea Maluna komo ai ka make kiʻekiʻe o ka papa kuhikuhiE leki uea paia ake puzyrnoholedohealnym fistula (Csendes):

• E kikokiko au -'ōpā pū i ka pono leki uea pohaku'ā'ī ake gallbladder a me ka leki uea.
• ʻAno II - imua o ka vesico-holedohealnogo fistula? Iaeoe emi o 1/3 o ka huina anapuni o ka leki uea o ke akepaʻa;
• ʻAno III - imua o ka vesico-holedohealnogo fistula, a ninoaaeyao 2/3 o ke anapuni o ka leki uea o ke akepaʻa;
• ʻAno IV - imua o ka vesico-holedohealnogo fistula, a lawe piha anapuni hepatic leki uea, ai ka leki uea paia ua hoolilo i ka hoʻopiha i ka make loa.

Kumu o ka maʻi pale ulu

I ka papa kuhikuhiE kumu o keia maʻi like Mirizzi maʻi pale i:

• mīkini'opihia lumen bile leki uea externally Hoonaukiuki calculous huʻi cholecystitis;
• imua o ka bile leki uea stricture aia mawaho o ka aina o ke akepaʻa;
• hepaticocholedochus ho okumu ana o perforations ma ke alo o ka stricture;
• ulu ai ke vesicovaginal fistula holedohealnogo laua hoʻopau o ka stricture.

Ke kaumaha ma muli o ka 'ole o biliary ducts, ka nui a me ke kaumaha o ka pōhaku, e like me ka pono me ki ina hana like o ka lapaʻau kaʻina hana i hiki ke wehe' ia ma kekahi o nā luna a me ke kapuai, akā, me ka hou 'mai hōʻemi iki mīkini'opihia o ka bile leki uea ma ka vesico-holedohealny fistula hiki ke malama i gallstone maʻi wale.

Mīkini'opihia i lālā i loko o bile leki uea stricture inaʻoki kino ua hoʻokaʻulua, a me ka maʻi lilo maʻi palapala, ma i ke au o ke kala ua auou caiaiai ihu lua. A hiki i ka manawa o ka gallbladder paia a me hepaticocholedochus hoʻomakaʻia ke i triggered i ka pohaku nui i loko o ke eke o Hartmann. Ma lalo o ka puʻe o kona kaumaha deteriorating trophism aicieeaao decubitus gallbladder paia a me ka leki uea. A laila, puzyrnoholedohealny fistula ua hana.

Ma keʻano o ia ka pathological hoike mai ka gallbladder i loko o ka lumen hepaticocholedochus haule ana concretions. Fistula nui ae la ka anawaena ma ka hoemi kona'aʻaʻa mīkini'opihia ciia. E like me ka hopena, pilikia, ua hoemiia ka hou ana o ka proximal hapa o hepaticocholedochus ka gallbladder i ka nui, e nalo'ā'ī, Hartmann eke, a me ka nui loa o ke kino. E like me ka hopena, i ka gallbladder lilo e like divertikulopodobnoe hoʻonaʻauao, i mea i ka manaʻo me ka lumen o extrahepatic bile leki uea hoʻohana 'ana i ke ākea anastomosis. E like me ka rula, aole no he Oe pele.

symptomatology

Pehea i Mirizzi maʻi pale? Symptoms ano o ka cholecystitis ia lŘlŘ ka huʻi paha maʻi ano me ka hooulu ana a me mechanical jaundice. I ka lehulehu o nā mea maʻi i loko o ka memo 'inikua hou na gallstone maʻi me ka pinepine ho'āhewa wale, cyclical me mechanical jaundice. About iao? Ikepili, ka brightest a me ka loa pinepine hoikeia symptoms nāʻeha i loko o ka luna akau abdomen. Pain a jaundice no ma 60-100% o ka hihia.

Jaundice hōʻike pinepine i loko o ke alo o ka vesico-holedohealnogo fistula.
I ka cholangitis kaulana kuni. I kekahi manawa, hoopilikia eha i loko o ka hypochondrium, intoxication, e ulu ai o ka pancreatitis (ʻoihana'ē aʻe e like me ka uhi ma luna o ka hoʻomaopopo like maʻi). Ma ke koko maoli o ka uku o ka bilirubin, Alt, AST, a me kona'ākilikai phosphatase.

ʻO wai lā ka mea nui, he pono ole?

Mirizzi maʻi pale ia lŘlŘ ma 0,1% o nā mea maʻi i ke alo o ka gallstone maʻi. Ināʻoki lāʻau lapaʻau 'uao ua malama i 0.7-2.5% o nā mea maʻi. Poe mai, na kane a me na wahine a pau loa lakou lahui, a me nā lāhui kanaka a pau. I ka wa elemakule, maʻi ia lŘlŘ nui aku pinepine ia.

ki ina hana like o kaʻike,

He aha mea ka ka manaʻo pohihihi o ka iapaau ana o na maʻi like Mirizzi maʻi pale? ʻike, a me kaʻoki lāʻau lapaʻau hoʻokokoke uaʻaʻole maopopo hoakaka.

Ma ke kālā no lapaau, aole meaʻaʻohe nui maliu rula no e mālama nei PalekanaEND_LINK kaʻina hana. I loko nō o ka holomua i loko o ke kula o ka 'inikua kiʻi likeʻole maʻi, i kaʻike, hana ua kukulu no hoi iluna me ka pilikia. Kēia hana ma kahi o 20% o ka hihia. Wale i kekahi mau noiʻi Ua kaulana ia ultrasound o ka maʻi ma mua o ka hana ino i ka kūlike loa ka pale kaua o 67,1% o ka hoopii, MRI - i loko o 94,4%, intraductal ultrasound - ma ka 97% a me ka endoscopic retrograde cholangiopancreatography - 100%.

A pau o keia paipai i ke kālā no ano o vocalʻike, aole ia e mau ana e ka mea hiki ke kuhikuhi i Mirrizi maʻi pale i loko o ka wā mua o ka hana.

Loa pinepine, ka wā ultrasound loaʻa nā kēia symptoms:

• palena manawa leki uea i loko o ke akepaʻa, a me kona proximal i kekahi ia laua i ka mea e like me ka leki uea unexpanded gallbladder;
• loaa gallbladder wrinkled moku'āina.

HI Mirizzi maʻi pale nā hoailona coincide me nā hiʻona 'akomi i ka ultrasound. ʻOiai HI hiki ole hoʻolako nui kula hope 'ike i ka ultrasonic nä iaoia, kona kūlana ma ka hoomaopopo ana i ke alo o ka maʻi' aʻai i loko o ka proximal ducts o ka gallbladder meaʻano kiʻekiʻe, i mea nui i loko o ka differentiation Mirrizi maʻi pale me ke alo o ka maʻi 'aʻai.

ʻume mākenēki resonance kiʻi, endoscopy a me retrograde cholangiopancreatography (ERPHG) PalekanaEND_LINK ki ina hana like e like me ka pili ana i nä a me ka stricture holetsistoholedohealnogo fistula. Nā kiʻi i loko o ke ano T1 a me T2 hiki e hou pololei hoomaopopo li nui mai ka maʻi 'aʻai, ia mea he pono a me ka HI ultrasound mau ole. Eia naʻe, ma muli o ia i ke kumu kuai kiʻekiʻe o ka hoike ma ka MRI keia PalekanaEND_LINK iaoia ua i pili i nā mea a pau ola kino-oaio? A.

ʻume mākenēki resonance cholangiopancreatography mea he kŘpa a hou, akā, uuku? Anoee 'ano o kaʻike,. Kekahi mau kānakaʻepekema nānā mea like me ka loa, olelo pomaikai oia wale, e hoʻokohu 'ia na pathology me Mirrizi maʻi pale.

Kekahi mau kānakaʻepekema i aku nei au i loko o kā lākou mau palapala na pono o laparoscopic ultrasonography pancreatoduodenal wahi. Maʻoki kino no kēiaʻike o knm keia iaoiaʻo ia ka mea hiki ke kūkulu i ka maoli-manawa kiʻi o ka bile ducts i loko o kekahi mau Kekoa hua o kekahi pana pua. Currently, naʻe, i kēia iaoia koe inaccessible a unexplored a hiki i ka hopena.

It E e kaulana ia, hoʻowahāwahā i ke ola ana o kekahi mau ano o kaʻike,, e hookupaa i ke alo o ke knm mea nō paʻakikī loa, a hiki mai i ka surgeon auwana, a i poho i ka pono bile leki uea, a ua hewa ike like me ka laau awaawa, bladder a he ākea pele. I ka nele o ka nui oluolu ki ina hana like o kaʻike, ma muaʻoki kino ua hookuke, e kūkulu i ka maikaʻi loaʻaoʻao.

lapaʻau Nā Kūlana

Pehea eliminated Mirizzi maʻi pale? Iapaau ana kŰia ka papa kuhikuhiE wahi elua: rentgenoendoskopichesky iaoia aʻoki lāʻau lapaʻau 'uao.

Rentgenoendoskopicheskyʻano o ka hana hiki e pili me ka keʻehi mua mamua, eʻoki kino i ka makaukau no kaʻoki kino. He hana me he kuokoa iaoia o ka hana maikaʻi o nā mea maʻi i ke alo o SM ma ka hihia o ke kiʻekiʻe anesthetic kamepiula.

Ke keakea REV nui noiʻi loaʻa:

• pāhawewe waiū i nā mea maʻi a me ka 'inikua kookoo;
• kiʻekiʻe uku no ka endoscopy a me ka X-Ray keia hookolokolo ana;
• i ka hikiʻole, e hoʻopau i ka hou ana o ka lumen o proximal hapa o ka pono bile leki uea.

E like me ka 'epekema moʻokalaleo lauwili loa mawaena o lakou ihoʻaoʻao o operative' uao. Aia i nā koho no kaʻoki lāʻau lapaʻau ana ma SM.
Kekahi kauka manaʻo e Mirrizi malamaia lakou ma ka laparoscopy maʻi pale ua loa contraindicated.

Ma ka hou e like me ka ano o ka hana i ka wa a keʻano mua ka cholecystectomy maʻi pale, i ua inā ma ka ninini choledoch.

Pehea hoomahaia ma ke alo aku o ka fistula biliobiliarnogo Mirizzi maʻi pale? Situational hana pono kaawale ana a me ke ola hloledoha ano hoopono. E like me kekahi o na aoao o ka panina o ka pono bile leki uea, a ua noi e ka hapanui o ka surgeons mea, e hoʻopau i ka hewa o kona pā pōhaku ma haʻalele hapa o ka laau awaawa, bladder. Naʻe, kekahi kauka manaoio i ka waiho ana i ka'aʻaʻa ke hoʻonui i ka pilikia o ke koena choledocholithiasis.

Ma ke alo o ka fistula holetsistobiliarnogo waiho i ka manaʻo o ka mea pono bile leki uea stents lula ea ma ka pokole maoli. Ka nele no kēia 'ano o ka hana, he nuiʻepekema wehewehe aku i ke alo o ka loa-manawa nā loli' ia i loko o ka wahi o ka hoʻoʻino ano hepatoduodenal ligaments, ai ka SM hiki ke ike i poho kŘkohu bile leki uea pā. Ma kā lākou nui deformation bile leki uea paia i komo i loko o ka fistula.
Maʻoki kino, he mea he nui kiʻekiʻe o ka pilikia o complications.

hiki complications

Loa pinepine ia ia lŘlŘ ma hope oʻoki kino o ka complication me na bile leki uea stricture. E like me ka mea Lūkini kanaka noiʻi GI Dryazhenkova (2009) o 46 nā mea maʻi i akaaka maluʻoki kino, stricture iloko i ka 6.5%.

He aha nā hualoaʻa o ana i ka ai-kapaia nalowale nōkahea, i ka i eha nā mea maʻi me ka loiloi mua palapala kenimika (stenotic nānaina)? Noiʻi V. S. Savelev, VI Revyakin (2003) kaulana i ka maikaʻiʻano o ka maʻi, nae, wehewehe aku i ke ana o ka leki uea wahi o ka nōkahea'ōnaehana i ka kēia mau kumu:

• ulu o ka jaundice;
• nōkahea iaʻi hoʻonāukiuki aku i ke kahua o ka poe liilii, calculi;
• paʻakai palapala moʻopane ma luna o nā paia o ka nōkahea;
• hoʻomāhuahua o detritus, like me ka hana mau ana i ka putty e hoʻonāukiukiʻana mai o recurrent ho'āhewa wale o ka cholangitis.

I ka lani kiekie loa degere o ka pilikia o ka hana mea ma luna o nā mea maʻi me ka degere kiʻekiʻe o na bile leki uea paia luku. Inā i ka maʻi i loko o ka ekolu a me ka ha o ke kahua, ka mea, ua kaulana he oi aku ka make ana ma hope oʻoki kino. I ka wā o ka maʻi o Nyos i loko o ke kolu a me ka ha o ka 'ilikai, ka hapanui surgeons lokomaikaʻiʻia i ka holedohoeyunoanastomoza.

Lapaʻau ma hope oʻoki kino

Like docked Mirizzi maʻi pale? Lapaʻau ma hope oʻoki kino komo ai i ke koko ma ka helu pono hoihoi i ka ia la ae, ma hope o ka hana, hoʻokahi pule a me kekahi lā ma mua hookuuia mai o ka haukapila. Sutures i wehe 'ia ma luna o 10th ka lā.

Ka awelika loihi o ka haukapila noho nei 10-12 lā. Ka huina lōʻihi like 'ole o ka loaa au, he mau mahina.
Nō kāu, e hoomanawanui i hōʻike koena i loko o ka sanatorium i loko o ka hoʻopulapula 'Oihana.

ka hopena

I ka lā Mirizzi maʻi pale, Mea Maluna,ʻike, a me ka hana o ka i i ho'ākāka 'ia i loko o kēia' atikala, lapaʻau ua manaʻo like kekahi o na complications o gallstone maʻi. Naʻe, i loko o ke kahua o kaʻike, a me kaʻoki kino nei no ka helu o unresolved nīnūnē.

I loko nō o ka mea i loaʻa o ke ākea huahelu o nāʻano aʻoki lāʻau lapaʻau 'uao, lapaʻau hualoaʻa mai i mau halawai pu me ka mea i manaoia.
Iloko o ka hana, a mahuahua nui intra- a me ka postoperative complication kōmi.

Hihia i loko o ka hoʻokō 'PalekanaEND_LINK hana, o ka pilikia o ka poho o ka bile leki uea, ka mea uuku helu o nā loina, a me ka waiwai pae o ki ina hana like o kaʻoki kino i ka elue no ka oi ma-hohonu, study o ka pilikia.

I ka hoike ana o ke kālā no nā loina o kaʻike, a me ka hooulu ana a pau e pono ai nā kaʻa mokulele i loko o ka mahinaʻai o keʻoki kino ke kaumaha ma muli o ka kahua o ka maʻi mau hiʻohiʻona nō hoomanawanui, e hoʻoikaika Inc me keia complication o ka cholelithiasis.