疾病治疗中值得注意的Mirizzi综合征(附24例报告)

MIRIZZI SYNDROME:A NOTEWORTHY ASPECTS OF DISEASE TREATMENT(24 CASES REPORT)

目的 提高Mirizzi综合征的识别和减少手术处理上的失误.方法 对1992年1月～2005年10月经手术证实为Mirizzi综合征的24例患者进行回顾（同期胆囊切除术共1771例）.结果 24例Mirizzi综合征患者中,Ⅰ型19例（79.2%）,Ⅱ型4例（16.7%）,Ⅲ型1例（4.2%）.仅6例患者术前经ERCP检查得到确诊.其中54.2%的患者在术前伴有症状,1/3患者肝功能检测正常,4例（16.7%）患者发生胆管损伤.Ⅰ型全部行胆囊切除术,Ⅱ型和Ⅲ型作＂T＂管引流和胆肠内引流术,胆管损伤的4例患者中1例行＂T＂管引流,其余3例行胆肠内引流术.除1例外,其余Mirizzi综合征患者全部治愈.结论 Mirizzi综合征的术前诊断较困难,ERCP对鉴别胆囊胆管瘘和内镜下置管有帮助,只有在手术中仔细地解剖Calot三角,才能减少发生胆管损伤的可能性.

Objective To raise diagnostic awareness and reduce fault in operation through analysis of Mirizzi syndrome cases. Methods A retrospective review of 24 cases of Mirizzi syndrome from January 1992 to October 2005 was performed. A total of 1771 cholecystectomies were performed during that period. Results Of the 24 patients, 19（79.2 %） were Mirizzi type Ⅰ, 4（16.7 %） were type Ⅱ, 1（4.2 %） was type Ⅲ. Only 6 patients were diagnosed after examination with endoscopic retrograde cholangiopancreatography （ERCP）. And 54.2 % of patients were symptomatic before operation. One-third of patients was normal by liver function tests. Bile duct injury occurred in 4 patients（16.7 %）. The patients with Mirizzi type Ⅰ was treated with cholecystectomy, while types Ⅱ and Ⅲ cases were treated with either T-tube insertion or biliary bypass procedures. Four patients who have bile duct injury were successfully treated with T-tube in one patient while the others went on to biliary bypass operations. All the patients recovered well except one patient. Conclusion The preoperative diagnosis of Mirizzi syndrome is more difficult. ERCP is helpful to identify cholecystocholedochal fistulas and to place stent with endoscope. It will reduce the possibility of bile duct injury only with intraoperative dissection of the Calot＇s triangle careful in Mirizzi syndrome.