小胆囊大隐患-Mirizzi综合征的诊断与治疗  

Small gallbladder with big hidden danger-diagnosis and treatment of Mirizzi syndrome with 33 patients reports

作　　者：魏志力 梁刚 张小弟 耿智敏[2] 

机构地区：[1]核工业咸阳215医院肝胆外科二病区,咸阳712000 [2]西安交通大学第一附属医院肝胆外科

出　　处：《肝胆外科杂志》2012年第4期286-288,共3页Journal of Hepatobiliary Surgery

摘　　要：目的探讨Mirizzi(Mirizzi syndrome,MS)综合征的诊断及治疗策略。方法回顾性分析我院2007年1月至2011年4月收治的33例经手术证实为Mirizzi综合征患者的临床资料。结果 33例Mirizzi综合症病人中仅3例(9.09%)术前确诊。15例Ⅰ型患者行单纯胆囊切除术;12例Ⅱ型和3例Ⅲ型,其中,14例行胆囊切除+胆道修补+T管引流术,1例行胆囊切除+Roux-en-Y胆肠吻合术;3例Ⅳ型患者均行胆囊切除+Roux-en-Y胆肠吻合术。33例患者中行腹腔镜治疗4例,其中3例中转开腹手术,1例成功实施腹腔镜胆囊切除术。结论 Mirizzi综合征术前确诊困难,术前诊断不明确或者术中处理不当可能会严重影响患者生活质量。结合临床特点、B超、ERCP或MRCP检查可以提高Mirizzi综合征的术前确诊率,手术方式应据根据胆管缺损的类型及局部炎症反应状况决定。对于术前怀疑为Mirizzi综合征的患者,开腹手术为治疗首选。Objective To explore the characteristics of the diagnosis and treatment to Mirizzi syndrome. Method The clini- cal data of 33 cases with Mirizzi syndrome proved by operation were analyzed retrospectively. Result Only 3 cases （9.09%） were di- agnosed correctly before operation. Of 33 cases, type I （n = 15 ） were performed with cholecystectomy; 14 cases of type H （n = 12 ） and type Ill （ n = 3 ） were performed with cholecystectomy , repair the bile duct and the T tube drainage, 1 case was performed with Roux-en-Y hepaticojejunostomy; typelV （n = 4） were performed with choleeystectomy and Roux-en-Y hepaticojejunostomy; 4 of the 33 cases were perfomed with laparoscopic cholecystectomy initially, 3 cases were converted to open surgery. Conclusion It＇ s difficult to diagnose Mirizzi syndrome preoperation. The history of the patient, ultrasonography, ERCP or MRCP can help to diagnose MS preoper- ation. The surgical procedure must be chosen according to different types of MS. Open cholecystectomy is the best choice for the pa- tients suspected with Mirizzi syndrome.

关 键 词：MIRIZZI综合征 诊断 治疗 腹腔镜胆囊切除 

分 类 号：R657.4[医药卫生—外科学]