Mirizzi综合征的内镜治疗

Endoscopic treatment of Mirizzi syndrome

目的探讨Mirizzi综合征患者的内镜治疗方法及意义。方法回顾性分析沈阳军区总医院内窥镜科2000年6月-2008年12月收治的26例Mirizzi综合征患者的临床和随访资料。26例患者均通过CT、MRI、超声等检查手段诊断,均采用内镜取石方法治疗。结果26例患者内镜诊断为Ⅰ型23例,Ⅱ型2例,Ⅲ型1例。21例内镜治疗成功,5例经内镜引流术后择期外科手术治疗,死亡率为0%。合并胆道结石患者8例,伴有胆囊多发结石7例。9例应用鼻胆囊引流,16例应用鼻胆管引流,13例应用胆道内支架引流。内镜取石术后24h患者腹痛缓解有效率为83.3%(15/18),完全缓解率66.7%(12/18),内镜引流术后患者黄疸和发热体征均明显改善,术后至出院所有患者均未发现内镜治疗并发症。结论对Ⅰ、Ⅱ型Mirizzi综合征患者,内镜取石是一种安全、有效的治疗方法。对于外科手术治疗前的Ⅱ和Ⅲ型Mirizzi综合征患者,内镜胆管引流术对于缓解梗阻性黄疸具有重要意义。

Objeclive To evaluate the endoscopic treatment strategy and clinical sense for patients with Mirizzi syndrome. Methods The clinical and follow-up data of 26 patients with Mirizzi syndrome were retrospectively studied. All patients were diagnosed or suspected as Mirizzi syndrome by CT, MRI or US before endoscopic examination. All cases were treated by endoscopic stone extraction. Results Of 26 patients with Mirizzi syndrome belonging to 3 types by endoscopic retrograde cholangio-pancreatography （ERCP）, 23 cases were TypeⅠ, 2 typeⅡ and 1 type Ⅲ Endoscopic stone extraction was successfully performed in 21 patients. Five patients were given elective surgery after endoscopic temporary drainage The mortality and morbidity were zero. Mirizzi syndrome with bile duct stones was found in 8 cases, and with cholecystolithiasis in 7 cases. Naso-gallbladder drainage was used in 9 patients, naso-biliary drainage was used in 16 patients, and biliary plastic stents were used in 13 patients. The effective remission rate of abdominal pain was 83. 3%（15/18） 24 hours after endoscopic stone extraction, and the complete resolution rate was 66. 7% （12/18）. After endoscopic bile duct drainage, jaundice and fever were resolved obviously. No complications were found in the patients who underwent the endoscopic therapy after the operation until discharge Conclusions Endoscopic stone extraction is safe and efficacious in patients with type Ⅰ and Ⅱ Mirizzi syndrome. In patients with type Ⅱ and Ⅲ Mirizzi syndrome before surgical treatment, endoscopic bile duct drainage plays an important role in relieving the obstructive jaundice.