经内镜乳头胆囊引流术治疗Mirizzi综合征并发梗阻性化脓性胆囊炎  

Endoscopic transpapillary gallbladder drainage for Mirizzi syndrome accompanied with obstructive suppurative cholecystitis

作　　者：麻树人[1] 赵志峰[1] 张宁[1] 杨卓[1] 赵云峰[1] 张迎春[1] 韩笑[1] 宫照洁[1] 杨琳[1] 

机构地区：[1]沈阳军区总医院内窥镜科,110016

出　　处：《中华消化内镜杂志》2009年第12期625-628,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨经内镜乳头胆囊引流术治疗Mirizzi综合征患者并发梗阻性化脓性胆囊炎的临床意义。方法回顾性总结8例患者的临床资料。8例患者均有急性右上腹痛，Murphy征阳性，经影像学和ERCP诊断为Mirizzi综合征Csendes分型Ⅰ型，胆道结石合并梗阻性化脓性胆囊炎。治疗方法为经内镜ERCP取石及相应治疗，继之行经乳头鼻胆囊引流术。结果8例均经内镜成功完成取石及鼻胆囊引流术，未发生并发症及死亡。术后患者胆囊区疼痛均明显缓解，体温、白细胞逐步恢复正常；1周后影像学检查显示胆囊及周围炎症明显好转或消失。6个月时随访，2例患者偶有胆囊区不适感。结论Mirizzi综合征的内镜取石治疗疗效确切，经内镜乳头胆囊引流术治疗其伴发的梗阻性急性化脓性胆囊炎在迅速缓解感染、减轻临床体征方面具有重要的作用。Objective To evaluate endoscopic transpapillary gallbladder drainage （ETGD） for Mirizzi syndrome accompanied with acute obstructive suppurative cholecystitis. Methods Data of 8 cases, who presented with acute right upper quadrant abdominal pain and positive Murphy sign and were diagnosed by imaging and endoscopic retrograde cholangiopancreatography （ERCP） as having Csendes type Ⅰ of Mirizzi syndrome, were retrospectively studied. The cholelithiasis with obstructive suppurative cholecystitis were treated with stone removal via ERCP and subsequent ETGD. Results ETGD was successfully performed in all patients, and no complications or death occurred. The symptoms relieved after the procedure, and body temperature and white blood cells gradually decreased to normal level. Imaging findings one week after ETGD showed subsidence of gallbladder inflammation. All patients remained symptom free at follow-up of 6 months, except occasional discomfort in gallbladder area in 2 patients. Conclusion Endoscopic treatment is safe and effective in patients with Mirizzi syndrome. ETGD is able to relieve infection and clinical symptoms in such patients accompanied with acute suppurative cholecystitis.

关 键 词：胆囊炎 胰胆管造影术 内窥镜逆行 MIRIZZI综合征 经内镜乳头胆囊引流术 

分 类 号：R657[医药卫生—外科学]