Ⅰ型Mirizzi综合征的磁共振胰胆管水成像诊断及手术治疗  

MRCP helps establish surgical modality for type Ⅰ Mirizzi syndrome

作　　者：郭建猛[1] 栗光明[2] 张栋[3] 程丹桂[1] 

机构地区：[1]长治医学院附属和济医院普外三科,山西省046000 [2]北京同仁医院肝胆外科 [3]长治医学院附属和济医院磁共振室

出　　处：《中华普通外科杂志》2017年第5期438-441,共4页Chinese Journal of General Surgery

摘　　要：目的探讨Ⅰ型Mirizzi综合征诊断中磁共振胰胆管水成像（magnetic resonance cholangiopancreatogfaphy，MRCP）的应用与手术方式的选择。方法回顾性分析I型Mirizzi综合征患者的MRCP资料，分析其诊断方法及手术方式的选择。结果依据MRCP征象选择术式．MRCP上显示胆总管梗阻超过1／3、胆囊大、胆囊管结石靠近肝门部选择开腹胆囊切除术，反之选择腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）。MRCP检查组23例Ⅰ型患者16例选择LC，7例选择开腹胆囊切除术。22例患者按术前预定的手术方案完成手术，1例中转开腹，而未做MRCP检查组23例患者术前未获确诊．LC12例，7例中转开腹。11例开腹胆囊切除术。MRCP组Ⅰ型Mirizzi综合征术前确诊率为82．6％（19／23），预定的手术方式成功率为95．7％（22／23）。而未行MRCP检查患者，术前均无法确诊，LC中转开腹率高达58．3％（7／12）。结论MRCP检查在Ⅰ型Mirizzi综合征术前诊断中起至关重要的作用．同时可准确地指导手术方式的选择。Objective To evaluate magnetic resonance cholangiopancreatography （MRCP） in identifying Mirizzi syndrome and surgical modality Methods According to MRCP identification open laparotomy was adopted for those 7 case with gallbladder enlargemeng incarcerated stones close to the hilum and long segment obstruction of the common bile duct. Other 16 type I Mirizzi syndrome cases without these characteristics underwent LC. Results Among 23 patients in MRCP group 22 cases were successfully operated on based on preoperatively planned surgical procedures. Only one was converted to open surgery because of the variation of gallbladder artery. While in 23 cases without undergoing preoperative MRCP examination,7 out of 12 cases assigned to LC were converted to open cholecystectomy （OC）, 11 cases were done by OC. The Preoperative accurate diagnosis rate was 82.6% （ 19/23 ） in MRCP patients with type Mirizzi I syndrome. The success rate of preassigned surgical approach was 95.7% （22 / 23）. While in non-MRCP group , the conversion rate was 58.3% （7/12）, the average length of stay were significantly prolonged . Conclusions Preoperative MRCP examination helps accurately establish the diagrosis of type I Mirizzi syndrome, precisely plan appropriate surgical approaches.

关 键 词：MIRIZZI综合征 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R657.4[医药卫生—诊断学]