腹腔镜治疗误诊的Ⅲ型Mirizzi综合征1例报道并文献回顾  

Laparoscopic treatment of misdiagnosed Mirizzi syndrome typeⅢ: A case report and literature review

作　　者：樊银杰 王巍[1] 过灵香 孙宏治[1] 

机构地区：[1]辽宁医学院,辽宁锦州121001 [2]湖南中医药大学针灸推拿学院,湖南长沙410208

出　　处：《解放军医学院学报》2016年第3期278-282,共5页Academic Journal of Chinese PLA Medical School

基　　金：吴阶平临床科研专项资助基金(320.6750.1393);辽宁省科学技术计划项目(2013225305);辽宁医学院校长基金-奥鸿博泽研究生科研创新基金(AH2014014);辽宁省工业企业科技特派员行动项目基金(20130106)~~

摘　　要：目的探讨Ⅲ型Mirizzi综合征(Mirizzi syndrome,MS)的临床诊断和治疗方法。方法分析辽宁医学院附属第一医院2015年收治的1例Ⅲ型Mirzzi综合征的诊疗经过,并结合文献进行回顾性分析。结果患者男性,34岁,因上腹痛反复发作11年,加重伴巩膜黄染5 d入院。入院后肝功能检查提示为梗阻性黄疸,腹部超声、腹部CT及磁共振胆胰管造影结果考虑为胆囊结石、胆总管结石。完善术前准备后,行腹腔镜联合胆道镜胆囊切除、胆总管切开取石"T管"引流术。术中发现胆囊管与肝总管之间形成交通,即胆囊胆管瘘,诊断为Ⅲ型MS;遂更改手术方案为腹腔镜联合胆道镜胆囊切除、胆管瘘口修补成形术、胆总管切开取石"T管"引流术。术后给予抗炎、补液及对症支持治疗,术后两周行胆道造影,确定肝内外胆管通畅后拔除"T管",患者顺利出院。结论高度怀疑MS的患者应谨慎选择腹腔镜治疗。Objective To discuss the clinical diagnosis and treatment of Mirizzi syndrome（MS） type Ⅲ. Methods One case diagnosed with Mirizzi syndrome typeⅢin the First Affiliated Hospital of Liaoning Medical University in 2015 was enrolled in this study. The clinical diagnosis and treatment was reported and its related literatures were reviewed. Results A 34 years old man admitted to our hospital with upper abdominal pain on and off for 11 years and sclera jaundice of 5 days. He was initially diagnosed as gallstone and choledocholithiasis in inpatient department according to the liver function, abdominal ultrasound, abdominal CT and Magnetic Resonance Cholangiopancreatography. Surgical treatment plan was laparoscopic cholecystectomy, section of common bile duct, calculus remove and drainage with T tube. However, it formed cholecystobiliary connection unexpectedly（cholecistobiliary fistula） during operation, and the patient was diagnosed as MS typeⅢ. In consequence, choledochoplasty was performed. Cholangiography was carried out two weeks after operation, and it suggested that the extra-and intra-hepatic biliary were smooth. After removing the T tube, the patient was discharged. Conclusion It suggests that we should be cautious of choosing laparoscopic treatment for patients with highly suspected MS.

关 键 词：MIRIZZI综合征 胆囊胆管瘘 腹腔镜治疗 

分 类 号：R657.4[医药卫生—外科学]