Mirizzi综合征术中胆道损伤的处理与预防  

Operative Treatment and Prevention of Bile Duct Injuries for Mirizzi Syndrome

作　　者：蒋晓忠[1] 赵少勇[1] 朱勇[1] 王昌松[1] 龚光[1] 周文浩[1] 罗洪[1] 黄斌[1] 吕涛[1] 陶友江 熊义祥 

机构地区：[1]四川省宜宾市第二人民医院肝胆胰外科,宜宾644000

出　　处：《肝胆外科杂志》2013年第4期291-293,共3页Journal of Hepatobiliary Surgery

摘　　要：目的探讨Mirizzi综合征术中胆道损伤的处理及预防。方法对四川省宜宾市第二人民医院自2005年9月至2012年12月间收治的共65例Mirizzi综合征患者的临床资料进行回顾性分析。结果本组65例（含术前明确诊断者12例）均采用手术治疗。其中11例采用腹腔镜完成，54例采用开腹手术；有52例行完整胆囊切除术，胆囊大部分切除13例；同时行胆总管探查者21例；11例胆囊胆管瘘口采用直接缝合修补；用胆囊瓣瘘口修补加胆总管探查5例；1例用肝圆韧带作瘘口修补、胆总管探查T管引流术；3例直接行肝总管空肠Roux—en—Y吻合术。共有9例（13．85％）术中发生胆道损伤，采用胆管损伤直接修补者2例，行胆道损伤整形修补加胆管探查T管引流术2例，胆总管对端吻合T管支撑引流1例，胆管空肠Roux—en-Y吻合3例，胆总管外引流后Ⅱ期行肝管空肠盆式吻合术1例。术后发生胆漏者13例，均经腹腔引流6—24d后自愈，无其他严重并发症。结论Mirizzi综合征术前诊断困难，术中明确诊断是防止胆道损伤的关键，处理时按各类型的特殊性作相应的手术处理，可获得良好效果。Objective To explore the operative treatment and prevention of bile duct injuries for Mirizzi syndrome. Methods The clinical data of 65 cases with Mirizzi syndrome from September 2005 to December 2012 in our hospital were analyzed retrospec- tively. Results Twelve cases were diagnosed prior to operation. All the 65 cases underwent surgical operation, including laparoscopic eholecystectomy in 11 cases and open cholecystectomy in 54 cases. The operative styles included simple cholecysteetomy in 52 cases, partial cholecystectomy in 13 cases ; eholecystectomy plus common bile duct exploration with T tube drainage in 21 cases; simple fistula repair for bile duct in 11 cases, closure of fistula with pedicle gallbladder flap in 5 cases and with ligamentateres hepatis in 1 case, choledochojejunostomy in 3 cases. There were 9 cases （ 13.85% ） with bile duct injuries which were treated with simple repair for bile duct injuries in 2 cases, bile ductal plasty plus T-tube drainage in 2 cases, common bile duct reconstruction by end-to-end anastomosis with T-tube drainage in 1 case, Roux-en-Y choledochojejunostomy in 3 cases, hilar-enteric anastomosis following extra drainage in 1 case. There were occurrences of bile leakage in 13 cases which were cured by drainage for 6 to 24 days. Conclusions It is still diffi- cult to diagnose Mirizzi syndrome preoperatively, and correct intraoperative diagnosis can decrease the occurrence of bile duet injuries. Appropriate surgical operative patterns should be selected according to different types of Mirizzi syndrome.

关 键 词：MIRIZZI综合征 胆囊切除术 胆结石 胆管炎 梗阻性黄疸 

分 类 号：R657.4[医药卫生—外科学]