开腹与腹腔镜胆囊切除处理Mirizzi综合征的比较

Comparision between conventional cholecystectomyand laparoscopic cholecystectomy in treatmentof Mirizzi’s syndrome

目的:比较开腹与腹腔镜胆囊切除术处理Mirizzi综合征的利弊.方法:对2002-01/2006-01收住我院胆囊结石、急慢性胆囊炎患者中的34例Mirizzi综合征进行回顾性分析.比较开腹与腹腔镜胆囊切除处理Mirizzi综合征的手术时间、术后住院天数和术后并发症;分析术前B超和肝功能检查与Mirizzi综合征的关系.结果:Ⅰ型Mirizzi综合征腹腔镜手术时间与开腹手术比较无明显差异,术后住院天数短于开腹手术(9.33dvs4.57d,P<0.01),两组均未出现并发症.术前B超发现胆囊颈管结石嵌顿伴肝总管扩张和肝功能异常者与Mirizzi综合征密切相关(P<0.001).结论:腹腔镜胆囊切除处理Ⅰ型Mirizzi综合征可缩短术后住院天数.术前B超可提高Mirizzi综合征的诊断率.

AIM： To compare advantages and disadvantages between conventional cholecystectomy and laparoscopic cholecystectomy in the treatment of Mirizzi＇s syndrome. METHODS： Thirty-four cases of Mirizzi＇s syndrome were selected from patients with cholecystolithiasis and acute or chronic cholecystitis in our hospital from January 2002 to January 2006. The operating time, post-operative hospital stay and complications were compared between conventional cholecystectomy and laparoscopic cholecystectomy in treatment of Mirizzi＇s syndrome; meanwhile, we analyzed the relations of pre-operative ultrasonography and liver function with the diagnosis of Mirizzi＇s syndrome. RESULTS： The operating time was not significantly different between conventional cholecystectomy and laparoscopic cholecystectomy, but the post-operative hospital stay after laparoscopic surgery was shorter than that after open cholecystectomy for type I Mirizzi syndrome （4.57 d vs 9.33 d, P 〈 0.01）. There were no complications in both therapies. The gallstone impaction in the cystic duct or gallbladder neck by pre- operative ultrasonography and liver dysfunction had close relations with the diagnosis of Mirizzi＇s syndrome （P 〈 0.001）. CONCLUSION： Laparoscopic cholecystectomy may shorten the post-operative hospital stay in treating type I Mirizzi＇s syndrome, and preoperative ultrasonography is very helpful for the diagnosis of Mirizzi＇s syndrome.