腹腔镜与开腹手术治疗Mirizzi综合征的临床疗效比较  

Comparison of laparoscopic and open surgery in the treatment of Mirizzi syndrome

作　　者：李明[1] 张大鹏[1] 隋晓军 刘军舰[1] 李宁[1] 王震宇[1] Li Ming;Zhang Dapeng;Sui Xiaojun;Liu Junjian;Li Ning;Wang Zhenyu(Department of Hepatobiliary Surgery,Tianjin Nankai Hospiatal,Tianjin 300100,China)

机构地区：[1]天津市南开医院肝胆外科,天津300100

出　　处：《中华肝胆外科杂志》2023年第12期897-901,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：天津市教委科研计划(2022KJ271)。

摘　　要：目的比较腹腔镜与开腹手术治疗Mirizzi综合征的临床疗效。方法回顾性分析2013年5月至2020年4月经天津市南开医院收治的125例经手术治疗的Mirizzi综合征患者的临床资料,其中男性59例,女性66例,年龄(57.7±13.6)岁。依据手术方式将患者分为腹腔镜组(n=84)和开腹组(n=41),比较两组患者术前一般资料、手术时间、术中出血量、术后并发症、术后住院时间及总住院时间的差异。通过电话或微信方式对患者进行随访,随访患者胆管结石复发、胆管狭窄等情况。结果与开腹组患者的术后住院时间13.00(10.00,17.50)d、总住院时间22.00(16.00,27.50)d相比,腹腔镜组患者的术后住院时间8.00(5.25,12.00)d、总住院时间15.00(10.25,22.75)均减少,差异有统计学意义(均P<0.001)。腹腔镜组患者中转开腹率为15.5%(13/84)。两组患者围手术期均无死亡。腹腔镜组患者与开腹组患者术后并发症发生率差异无统计学意义[9.5%(8/84)比7.3%(3/41),P>0.05]。腹腔镜组64例患者获得随访,随访率76.2%(64/84),随访期间死亡2例,复发胆管结石5例,胆管狭窄1例。开腹组37例患者获得随访,随访率90.2%(37/41),随访期间死亡4例,复发胆管结石4例。随访期间所有患者的死亡原因均与Mirizzi综合征无关。结论腹腔镜手术比开腹手术治疗Mirizzi综合征具有更少的术后住院时间和总住院时间,且未增加手术并发症和死亡,安全可行。Objective To compare the laparoscopic and open surgery in the treatment of Mirizzi syndrome(MS).Methods The clinical data of 125 patients with MS undergoing surgery in Tianjin Nankai Hospital from May 2013 to April 2020 were retrospectively analyzed,including 59 males and 66 females,aged(57.7±13.6)years old.Patients were divided into the laparoscopic group(n=84)and open group(n=41).General data,operation time,intraoperative blood loss,postoperative complications,postoperative and total hospital were compared between the groups.Patients were followed up and screened for biliary stone recurrence or biliary stenosis by phone or Wechat.Results The postoperative hospital stay[8.00(5.25,12.00)d vs.13.00(10.00,17.50)d,P<0.001]and total hospital stay[15.00(10.25,22.75)d vs.22.00(16.00,27.50)d,P<0.001]were shorter in laparoscopic group.The conversion rate of laparoscopic group was 15.5%(13/84).No perioperative death occurred in either group.The incidence of postoperative complications were comparable between the groups[9.5%(8/84)vs.7.3%(3/41),P>0.05].In laparoscopic group,64 patients were followed up[76.2%(64/84)].During follow-up,there were two deaths,five cases of bile duct stones recurrence and one case of bile duct stenosis.In open group,37 patients were followed up[90.2%(37/41)].During follow-up,there were four deaths,four cases of bile duct stones recurrence.All deaths during follow-ups were non-MS-related.Conclusion Compared to open surgery,laparoscopic surgery could shorten the total/postoperative hospital stay while does not increase the morbidity and mortality,which could be safe and feasible in the treatment of MS.

关 键 词：MIRIZZI综合征 胆囊次全切除术 胆管探查术 胆肠吻合术 

分 类 号：R657.4[医药卫生—外科学]