腹腔镜修复Mirizzi综合征所致的肝总管缺损

Laparoscopic repair of common hepatic duct defect caused by Mirizzi syndrome

目的探讨腹腔镜下修复Ⅱ、Ⅲ型Mirizzi综合征所致肝总管缺损的方法。方法回顾性分析腹腔镜下完成的8例Ⅱ、Ⅲ型Mirizzi综合征手术治疗的经验。8例均在腹腔镜下完成胆囊次全切除和肝总管缺损修补术，其中6例Ⅱ型患者缺损位于肝总管侧壁，通过残存胆囊管直接缝合修复缺损，2例Ⅲ型缺损分别位于肝总管前侧壁和后侧壁，采用残留部分胆囊壶腹部补片法完成肝总管缺损修复术。结果8例均在腹腔镜下完成胆囊次全切除及肝总管缺损修补术。手术时间80—150min，平均110min。术后随访6—24个月，无症状复发。结论必须熟悉Mirizzi综合征的解剖特点，熟练掌握腹腔镜下缝合技术，针对不同的缺损部位和范围，选择恰当的修补方法。

Objective To evaluate the repair of common hepatic duct defect caused by Type Ⅱ or Type Ⅲ Mirizzi syndrome laparoscopically. Methods Eight cases of Type Ⅱ or Type Ⅲ Mirizzi syndrome treated under laparoscopy were analyzed retrospectively. Among them six cases were identified as Mirizzi Ⅱ and a defect on the lateral wall of common hepatic duct was found and repaired by suturing the stubble of cystic duct. The two Mirizzi Ⅲ cases had a defect on front and lateral wall or back and lateral wall of common hepatic duct respectively. Both defects were repaired by a patch from the infundibulum of galllbladder. Results All the 8 cases underwent laparoscopic subtotal choleeysteetomy followed by repair of common hepatic duct defect. The operation lasted for 80 - 150 min （ mean 110 min ）. There was no recurrence of the symptoms after 6 - 24 months follow up. Conclusion The familiarity of the anatomical characters of Mirizzi syndrome and the skillful suture technique under laparoscopy are both necessary.