Mirizzi综合征的急诊手术治疗  

Emergency Surgical Treatment of Mirizzi Syndrome

作　　者：李红 尹轶 刘映昌 余怀玉 LI Hong;YIN Yi;LIU Ying-chang;YU Huai-yu(Department of General Surgery,Nanxian People's Hospital,Nanxian 413200,Hunan,China)

机构地区：[1]湖南省南县人民医院普通外科

出　　处：《中国现代手术学杂志》2019年第2期91-93,共3页Chinese Journal of Modern Operative Surgery

摘　　要：目的分析总结我院在急诊情况下治疗 Mirizzi 综合征的经验,探讨在急诊情况下 Mirizzi综合征的诊断和手术治疗方式。方法回顾性分析我院 2014 年 1 月至 2019 年 1 月,所有进行了急诊手术治疗诊断为 Mirizzi 综合征的患者的临床资料。结果根据纳入及排除标准,共 16 例伴有 Mirizzi综合征者进行了急诊手术治疗,根据改良型 Csendes 分类,患者分型:Ⅰ型 13 例,Ⅱ型 2 例,Ⅳ型 1 例。Ⅰ型的患者均为术中明确诊断。Mirizzi 综合征Ⅰ~Ⅱ型、Ⅳ型手术方式分别采用胆囊全切或次全切、胆囊切除加胆肠内引流术。术后痊愈 15 例,发生胆瘘 1 例。结论在急诊情况下,Mirizzi 综合征术前诊断困难,手术难度大。对不同类型的 Mirizzi 综合征应采取不同的手术方式及方法。胆囊次全切除术是大部分 MS Ⅰ型和 MS Ⅱ~Ⅲ型患者的最佳手术方式;MS Ⅳ~Ⅴ型患者应选择开腹胆肠内引流术。Objective To analyze and summarize our experience in the treatment of Mirizzi syndrome in emergency situations,and to explore the diagnosis and surgical treatments of Mirizzi syndrome in emergency situations. Method Retrospective analysis of the patients who underwent emergency surgery for the diagnosis of Mirizzi syndrome in our hospital was carried out from January 2014 to January 2019. Results There was a to- tal of 16 patients with Mirizzi syndrome underwent emergency surgery by inclusion and exclusion criteria. Ac- cording to the modified Csendes classification,there were 13 patients of type Ⅰ,2 patients of type Ⅱ and 1 of type Ⅳ. Mirizzi syndrome was diagnosed intraoperatively in the patients of type Ⅰ. Total or subtotal cholecys- tectomy was performed in MS type Ⅰ~Ⅱ and cholecystectomy and intra-biliary drainage was performed in type Ⅳ. All patients got cured except 1 case suffered from biliary leakage. Conclusion In the emergency setting, Mirizzi syndrome is difficult to be diagnosed before surgery,and the operation is difficult. Different surgical methods should be used for different types of Mirizzi syndrome. Subtotal gallbladder resection is the best surgical procedure for most patients with MS Ⅰ and MS Ⅱ~Ⅲ;while MS Ⅳ~Ⅴ patients should perform biliary-digestive anastomosis.

关 键 词：MIRIZZI 综合征 胆石症 胆囊炎 

分 类 号：R657.4[医药卫生—外科学]