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1、Mirizzi 综合征,病例讨论 2011.11.17,胆囊管或胆囊颈部结石压迫肝总管引起胆道梗阻症状，伴/不伴胆管瘘形成。 在胆囊切除患者中发病率0.7%1.8%。 男女发病率无明显差异，老年患者多见。,引起胆管梗阻的机制 机械性梗阻 （胆囊管与肝总管位置靠近） 继发胆管炎症,按是否合并胆管瘘分为两型：Type I - No fistula presentIA - Presence of the cystic ductIB - Obliteration of the cystic duct Types II-IV - Fistula presentII - Defect smaller th
2、an 33% of the CBD diameterIII - Defect 33-66% of the CBD diameterIV - Defect larger than 66% of the CBD diameter,推荐治疗方案： Type I Partial or total cholecystectomy, either laparoscopic or open. Common bile duct exploration is typically not requiredType II Cholecystectomy plus closure of the fistula, ei
3、ther by suture repair with absorbable material, T tube placement, or choledochoplasty with the remnant gallbladder.Type III Choledochoplasty or bilioenteric anastomosis (choledochoduodenostomy, cholecystoduodenostomy, or choledochojejunostomy), is required, depending on the size of the fistula. Suture of the fistula is not indicated.Type IV Bilioenteric anastomosis, typically choledochojejunostomy, is preferred because the entire wall of the common bile duct has been destroyed.,含气胆结石（Gas-Containing Gallstone）,胆结石化学成分与CT表现,结论胆结石中胆固醇含量较钙含量对CT表现的影响更大。,问题： 为什么胆结石中会含有“气体”？ “气体”的化学成分是什么？,Thanks！,
