54例Mirizzi综合征的腹腔镜治疗  

Laparoscopic management of 54 cases of Mirizzi syndrome

作　　者：李际辉[1] 郑成竹[1] 仇明[1] 柯重伟[1] 印慨[1] 沈炎明[1] 华积德[1] 

机构地区：[1]中国人民解放军第二军医大学长海医院普通外科,上海200433

出　　处：《中华普通外科杂志》2001年第6期334-335,共2页Chinese Journal of General Surgery

摘　　要：目的　探讨腹腔镜外科技术在Mirizzi综合征治疗中的地位。方法　对本院 1992年 5月至 1999年 12月完成的腹腔镜胆囊切除术 (LC) 96 0 0余例进行回顾性研究。对其中既往发作时有过黄疸者、入院化验检查提示阻塞性黄疸者或B超检查提示胆总管直径大于 0 8cm者 5 36例术前全部进行经内镜逆行胰胆管造影 ,发现符合Mirizzi综合征者 5 4例 ,占同期LC的 0 5 6 %。结果　 5 4例中5 0例Ⅰ型者 46例成功实施LC ,4例胆总管损伤者也在腹腔镜下一期完成缝合修复 ;4例Ⅱ型者中 3例一期缝合修复瘘口 ,1例用部分胆囊壁组织缝合覆盖于瘘口。手术均获成功。结论　Mirizzi综合征的Ⅰ型和Ⅱ型 ,依靠术者的经验和耐心细致的操作 ,是可以通过腹腔镜完成手术的。Objective To evaluate laparoscopic procedure in the management of Mirizzi syndrome. Method Retrospective study was carried out in 9 600 gall stone patients undergoing laparoscopic cholecystectomy (LC) from May 1992 to December 1999. Endoscopic retrograde cholangiopancreatography was done in 536 cases for one of the following reasons: 1. Jaundice history of cholecystitis, 2. Obstructive jaundice showed by serum biochemical study, 3. Enlargement of common bile duct (>0 8*!cm) found by ultrasound. As a result tentative diagnosis of Mirizzi's syndrome was established in 54 cases accounting for 0 56% of all LC patients.Results Laparoscopic procedure was successful in 46 out of 50 type Ⅰ cases. Four cases suffering from iatrogenic bile duct injury received primary repairment under laparoscopy. Fistulae repairment was successful laparoscopically in 3 out of 4 cases of type Ⅱ Mirizzi syndrome.Conclusion Type Ⅰ and type Ⅱ Mirizzi syndromes can be safely and successfully managed under laparoscopy in the hand of careful and skilled operators.

关 键 词：黄疸 胆结石 综合征 诊断 胆囊切除术 腹腔镜 治疗 

分 类 号：R657.4[医药卫生—外科学]