摘要
目的探讨Mirizzi综合征的诊断和治疗。方法回顾性分析35例Mirizzi综合征患者的临床资料。结果男性13例，女性22例，平均年龄62．3岁。术前确诊为Mirizzi综合征14例（40．0％），术中确诊21例（60．0％）。Ⅰ型9例，Ⅱ型18例，Ⅲ型7例和Ⅳ型1例。13例行腹腔镜手术，成功9例，另4例（30％）中转开腹手术。腹腔镜手术包括胆囊切除术7例，胆囊部分切除、术中胆道造影和经瘘管胆总管T管置入2例。开放手术的26例中，9例行单纯胆囊切除术，17例行胆囊部分切除，其中15例胆总管内置入T管引流，2例行Roux-en-Y肝管空肠吻合。术后发生并发症5例（14．2％），包括胆瘘3例，切口和肺部感染各1例，均经非手术治疗痊愈。无医源性胆管损伤和死亡。33例获随访1～5年，情况良好。结论重视Mirizzi综合征的术前诊断和术中辨认，尤其在腹腔镜胆囊切除困难时更应警惕，及时中转可减少甚至避免胆管损伤。术中胆道造影有助于了解病理改变，胆囊部分切除可以降低胆管损伤的风险，术后胆总管内应常规置入T管。如遇胆管壁毁损严重，适宜行Roux-en-Y胆管空肠吻合。
Objective To investigate the diagnosis and surgical treatment of Mirizzi syndrome. Methods The clinical data of 35 cases of Mirizzi syndrome treated by surgery were analyzed retrospectively. Results The 35 patients included 13 males and 22 females, with mean age of 62. 3 years. Forteen cases （40.0 % ） were diagnosed as Mirizzi syndrome preoperatively, and 16 cases （60. 0 % ） were recognized during operation. According to Csendes classification, 9 cases were type Ⅰ , 18 cases type Ⅱ , 7 cases type Ⅲ and 1 case type Ⅳ. Laparoscopic operation was performed in 13 patients, among them, 4 cases （30 % ） converted to open laparotomy. The laparoscopic operations included cholecystectomy in 7 cases, and partial cholecystectomy plus intraoperative cholangiography in 2 cases. Tweenty-six patients underwent open laparotomy, including cholecystectomy in 9 cases, partial cholecystectomy plus T-tube drainage in 17 cases, and Roux-en-Y hepaticojejunostomy in 2 cases. Postoperative complications included biliary leakage in 3 cases, infection of incisional wound in 1 case and pneumonia in 1 case, all the complications recovered by non-surgical treatment. Thirty-three cases were followed-up for 1 -5 years, the results were satisfactory. Conclusions The preoperative diagnosis and intraoperative identification of Mirizzi syndrome, especially during difficult laparoscopic cholecystectomy, should be emphasized, and timely conversion to open surgery could decrease the risk of bile duct injury. Partial cholecystectomy plus intraoperative cholangiography can be helpful to identify pathological change and to reduce the risk of iatrogenic biliary duct injury of Mirizzi syndrom. In the event of serious destruction of biliary duct, Roux-en-Y hepaticojejunostomy is feasible.
出处
《中国普通外科杂志》
CAS
CSCD
2008年第2期124-126,共3页
China Journal of General Surgery
