胆道修复手术在Mirizzi综合征大范围胆管缺损中的应用  

Choledochoplasty for major bile duct defect in Mirizzi syndrome

作　　者：梁斌[1] 黄晓强[1] 王敬[1] 夏红天[1] 刘博[1] 向昕[1] 董家鸿[1] 黄志强[1] 

机构地区：[1]解放军总医院肝胆外科,北京100853

出　　处：《中华肝胆外科杂志》2012年第10期743-746,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨修复手术在伴有大范围胆管缺损Mirizzi综合征中的应用。方法回顾分析2008年7月至2011年11月作者所在单位采用带血管蒂胃瓣修补治疗的3例伴有大范围胆管缺损者的Mirizzi综合征患者的临床资料。检索国内2001年1月至2011年1月，10年间有关修复方法治疗Mirizzi综合征的报道5篇，对检出的159例病例资料按Csendes分类，对其外科冶疗方法进行统计分析。结果3例胃瓣修复病例中，CsendesⅢ型2例，Ⅳ型1例。手术过程顺利。术后分别随访2年、3年、1年，平均随访2．5年，无胆管狭窄及胆管炎症等并发症发生。国内文献检索159例中，CsendesI型93例，采用单纯胆囊切除58例，胆囊大部切除＋剩余黏膜电凝消融35例；Ⅱ型40例，瘘口直接修补29例，带血管蒂胆囊瓣修补9例，脐静脉瓣修补2例；Ⅲ型20例，带血管蒂胆囊瓣修补9例，脐静脉瓣修补1例，带血管蒂胃瓣修补3例，胆管空肠Roux-en-Y吻合7例；Ⅳ型5例，均采用胆管空肠Roux-en—Y吻合，术后胆瘘1例，消化道出血1例，胆管狭窄1例，均治愈。结论对于存在胆囊胆管内瘘的Mirizzi综合征患者，应根据瘘口大小及修复材料，进行个体化的修复治疗。对于伴有较大缺损的胆管损伤，采用带血管蒂胃瓣修复胆道疗效确切，宜作为首选。Objective To evaluate the various methods of choledochoplasty in the repair of ma- jor bile duct defects in Mirizzi syndrome. Methods This is a retrospective study on 3 patient with Mi- rizzi syndrome with a large bile duct defect. These defects were repaired by using a vascular gastric pedicle patch in our department from July 2008 to November 2011. The authors searched the domestic medical literature on surgical repair for Mirizzi syndrome in the past ten years. The patients were trea- ted by various surgical methods, and they were analyzed according to the Csendes Classification. Re- sults There were no surgical complications in our three patients. There was one patient with a Csend- es type III ,while the remaining 2 patients were with Csendes type IV. At a median follow-up of 2.5 years, no patient developed signs of chronic cholangitis. In the medical literature, there were 93 pa- tients who were with Csendes type I ; and 58 patients were treated by cholecystectomy only, while 35 patients were treated by partial cholecystectomy plus mueosal ablation. Of the 40 patients with type II, 29 patients were treated by direct fistula repair, 9 patients by pedicle gallbladder flap and 2 patients by pedicle round ligament. Of the 20 patients with type III , 9 patients were treated by pedicle gallblad- der flap, 1 patient by pedicle round ligament, 3 patients by pedicle gastric flap and 7 patients by Roux- en-Y hepaticojejunostomy. For the 5 patients with type IV, they were treated by Roux-en-Y hepatico- jejunostomy. Of these 159 patients, postoperative complications included biliary fistula （n： 1）, upper gastrointestinal bleeding （n= 1）, and biliary stricture （n=1）. All the remaining patients were cured. Conclusion In patients with Mirizzi Syndrome, the choice of treatment depends on the size of the fis- tula. For patient with a major tissue defect in the common hepatic duct, a pedicle vascular gastric flap is a good treatment.

关 键 词：胆囊结石病 胆囊炎 胆管 修复外科手术 

分 类 号：R657.4[医药卫生—外科学]