Mirizzi综合征腹腔镜治疗的安全性分析  

The safety analysis of laparoscopic treatment for Mirizzi syndrome

作　　者：王晔飞 连凌云[1] WANG Ye-fei;LIAN Ling-yun(Department of General Surgery,the First Hospital of Yulin,Yulin 719000,China)

机构地区：[1]榆林市第一医院

出　　处：《腹腔镜外科杂志》2019年第11期846-849,共4页Journal of Laparoscopic Surgery

摘　　要：目的:探讨Mirizzi综合征行腹腔镜手术治疗的安全性。方法:回顾分析2013年1月至2018年7月31例经腹腔镜探查证实为Mirizzi综合征患者的临床资料,并对其影像特点及手术方式进行总结。结果:术前31例均行腹部B超,28例行MRCP检查。按照Csendes及Beltran分型,术中确诊Ⅰ型24例,21例行腹腔镜胆囊切除术(LC),1例LC中转开腹行胆囊切除,2例行LC+腹腔镜肝总管修补+胆总管探查T管引流;Ⅱ型3例,2例行LC+腹腔镜胆总管修补+T管引流,1例中转开腹行胆囊切除+胆总管修补+T管引流术;Ⅲ型2例,均中转开腹行胆囊切除+胆囊瓣修补肝总管+T管引流术;Ⅳ型1例,中转开腹行胆囊切除+肝总管空肠Roux-en-Y吻合;Ⅴa型1例,行LC+腹腔镜横结肠修补术。结论:影像学检查可提高Mirizzi综合征的术前诊断,大部分Ⅰ型及部分Ⅱ、Ⅴa型可在腹腔镜下顺利完成手术,而Ⅲ型、Ⅳ型局部解剖复杂,及时中转开腹可保障手术的安全性。Objective:To study the safety of laparoscopic treatment for Mirizzi syndrome.Methods:The clinical data of 31 patients who suffered from Mirizzi syndrome confirmed by laparoscopic exploration from Jan.2013 to Jul.2018 were retrospectively analyzed,and the imaging characteristics and surgical methods were summarized.Results:Abdominal ultrasound was performed in 31 cases and MRCP was performed in 28 patients before operation.According to Csendes and Beltran classification,24 cases were diagnosed as typeⅠ,21 cases underwent laparoscopic cholecystectomy(LC),1 case underwent LC and was converted to open cholecystectomy,and 2 cases underwent LC+laparoscopic hepatic duct repair+common bile duct exploration T tube drainage.3 patients were diagnosed with typeⅡ,2 cases underwent LC+laparoscopic common bile duct repair+T tube drainage,1 case was converted to open cholecystectomy+common bile duct repair+T tube drainage.Two patients with typeⅢwere converted to open cholecystectomy+common hepatic duct repair with gallbladder flap+T tube drainage.1 patient with typeⅣwas converted to open cholecystectomy+hepatic jejunal Roux-en-Y anastomosis.One patient ofⅤa type underwent LC+laparoscopic transverse colon repair.Conclusions:Imaging examinations can improve preoperative diagnosis of Mirizzi syndrome.Most of the typeⅠ,part of typeⅡandⅤa of Mirizzi syndrome can be successfully treated by laparoscopic operation.However,for typeⅢandⅣ,timely conversion to laparotomy can ensure the safety of operation.

关 键 词：MIRIZZI综合征 胆囊切除术 腹腔镜 安全性 

分 类 号：R657.4[医药卫生—外科学]