Mirizzi综合征的术前诊断及其不同类型的手术治疗分析(附86例报道)  

Analysis of Preoperative Diagnosis and Surgical Treatment Strategies for Different Types of Mirizzi Syndrome(Report of 86 Cases)

作　　者：李汛[1] 李玉民[1] 周文策[1] 张磊[1] 孟文勃[1] 何明彦[1] 朱克祥[1] 朱有权[1] 李世雄[1] 蒲小金[1] 李琼[1] 

机构地区：[1]兰州大学第一医院普外二科,兰州730000

出　　处：《中国普外基础与临床杂志》2009年第5期393-396,共4页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨Mirizzi综合征(MS)的术前诊断及对不同类型MS的相应手术治疗方法。方法自1990年3月至2008年12月期间收治经手术证实为MS的患者86例,其中男57例,女29例;年龄32～85岁,平均58岁;病程3个月～20年,平均13年;其中81例(94.19%)有黄疸病史及反复发作的胆绞痛病史。对86例MS患者的实验室检查,B超、CT、MRCP以及ERCP检查的术前确诊情况进行分析。同时依据Csendes分型,采取不同的手术治疗方法。结果B超对MS的术前确诊率为17.44%(15/86),CT为9.52%(4/42),MRCP为71.88%(23/32),ERCP为85.71%(48/56)。按Csendes分型:Ⅰ型20例,Ⅱ型43例,Ⅲ型17例,Ⅳ型6例。手术方式:Ⅰ型患者行胆囊全切或保留颈部的部分切除术;Ⅱ型行修补瘘口,瘘口下置T管引流术;Ⅲ型及Ⅳ型行肝肠吻合术。结论MS术前诊断较为困难,B超可作为辅助诊断方法,ERCP及MRCP能显著提高MS的术前确诊率;手术治疗应依据不同的病理类型选择最合理的术式。Objective To analyze the preoperative diagnosis and the operative methods for different types of Mirizzi syndrome （MS）. Methods Eighty-six cases of MS confirmed by operation were enrolled from March 1990 to December 2008. Their laboratory examination results and X-ray appearances of endoscopic retrograde cholangio- pancreatography （ERCP） were analyzed as well as B-ultrasonography （B-us）, CT scan and magnetic resonance cholangiopancreatography （MRCP）. According to the Csendes typing, different operative methods were adopted. Results The final diagnosis rate by ERCP for MS attained approximately 85.71% （48/56） in contrast with 17.44 % （15/86） by B-us, with 9.52% （4/42） by CT scan and with 7t. 88% （23/32） by MRCP. Twenty cases were Csendes type Ⅰ, 43 cases were type Ⅱ , 17 cases were type Ⅲ , and 6 cases were type Ⅳ. According to the Csendes typing, the cases of typeⅠ were treated by for the cholecystectomy or partial resection for reserving the neck of gallbladder, type Ⅱ by fistula reparation and laying up the T type drainage-tube under the fistula, and type Ⅲ and type Ⅳby the hepaticocholangiojejunostomy and hepaticoduodenostomy. Conclusion The preoperative diagnosis for MS is very difficult, B-us may be acted as an accessory diagnostic method. ERCP and MRCP can improve the rate of preoperative diagnosis for MS strikingly. The best reasonable method of the operative therapy is selected according to the different pathologic type of MS.

关 键 词：MIRIZZI综合征 诊断 Csendes分型 手术治疗 

分 类 号：R657.4[医药卫生—外科学]