腹腔镜、内镜在Mirizzi综合征I型患者中的应用(附11例报告)  

Application of laparoscopic and endoscopic procedures in patients with Csendes I Mirizzi Syndrome:report of 11 cases

作　　者：李广阔[1] 李鑫[1] 冯犁[1] 李水芹[1] 李莉[2] 张洁[1] 杨海霞[1] 

机构地区：[1]成都中医药大学附属医院肝胆外科,610072 [2]成都中医药大学附属医院放射科,610072

出　　处：《中华腔镜外科杂志（电子版）》2016年第2期100-105,共6页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

基　　金：成都市科技局“科技惠民计划项目”(2013)

摘　　要：目的探讨腹腔镜、内镜等微创技术在Mirizzi综合征（MS）CsendesI型患者“个体化诊疗＂中的应用。方法纳入成都中医药大学附属医院2013年11月至2015年12月施行腹腔镜胆囊切除术（LC）的患者900余例，进行回顾性分析。对病史中有黄疸、生化检查提示血胆红素升高和超声检查提示胆囊结石且肝总管或胆总管直径大于O．8em的患者，术前全部进行MRCP及ERCP，发现符合MS的患者24例，占同期LC患者的2．7％（24／900）。将其中CsendesI型11例纳入本研究，分析其临床特征及诊治特点。结果11例CsendesI型患者中，Csendes Ia型6例，3例合并继发性胆总管结石，其中2例发生急性胆管炎；CsendesIb型5例，2例合并继发性胆总管结石，其中1例发生急性胆管炎。所有患者行ERCP时一并清除胆总管内取石，留置ENBD管引流胆道，以改善肝功能。11例患者在ERCP后3～7d成功施行了LC，仅1例Ia型患者胆囊管结石嵌顿，于LC中中转开腹，经胆囊管行胆道镜下的碎石取石。结论怀疑MS的患者应行MRCP和ERCP，采用Csendes（1989，2008）标准进行准确分型，以便对肝外胆道的受损程度进行评估、合理抉择治疗策略。CsendesIa型和Ib型患者均可行LC，但术中应利用胆道镜进行胆囊管探查及碎石取石，尽可能避免胆道探查，以防止医源性目旦管狭窄.Objective To evaluate laparoscopic and endoscopic procedures in individualized diagnosis and therapy of Mirizzi Syndrome( Csendes Type I). Methods Retrospective study was carried out in 900 patients undergoing laparoscopic cholecystectomy( LC) from Nov. 2013 to Dec. 2015. Magnetic cholangiopancreatography( MRCP) and Endoscopic retrograde cholangiopancreatography( ERCP) were done in 24 cases( 24 /900,2. 7%) for the following reasons: cholecystitis with history of jaundice; abnormal bilirubin showed by serum chemical study; gallbladder stone( s) and enlargement( > 0. 8 cm) of intrahepatic or extrahepatic biliary tract by ultrasound. According the criteria of MS,24 cases were diagnosed and 11 of them were type 1 MS( Csendes classification),whose clinical data were analyzed retrospectively. Results All of the 11 cases underwent LC 3-7 days after ERCP,whose stones were removed and bile duct drained by ENBD. Only one case was converted laparotomy because of incarcerated cystic duct stones,which were be shattered and removed under choledochoscopy. Among the 11 cases,6 were Csendes Ia( 3 with secondary common bile duct stone,2 with acute cholangitis) and 5 were Csendes Ib( 2 with secondary common bile duct stone,1 with acute cholangitis). Conclusions Suspected patients with MS should be performed with MRCP and ERCP and classified with Csendes classification( 1989,2008) for evaluating damage ofextrahepatic biliary tract and choice of therapeutic strategy. Csendes Ia and Ib can be operated under laparoscopy, but stones in cystic duct should be explored and extracted after lithotripsy under choledochoscopy. Free of biliary tract exploration would be beneficial to avoid iatrogenic biliary tract stricture.

关 键 词：黄疸 胆囊结石 综合征 诊断 腹腔镜 内镜 

分 类 号：R657.4[医药卫生—外科学]