经内镜逆行胰胆管造影联合腹腔镜治疗Mirizzi综合征

Application of ERCP and laparoscopy to treatment of Mirizzi syndrome

目的探讨经内镜逆行胰胆管造影(ERCP)联合腹腔镜治疗Mirizzi综合征的优越性。方法回顾性分析20例Mirizzi综合征患者的临床资料。结果20例Mirizzi综合征患者均先行ERCP+EST+ENBD,待病情稳定后再行腹腔镜治疗:其中Ⅰ型10例、Ⅱ型6例均手术成功,成功率80%;另1例Ⅱ型、2例Ⅲ型,1例Ⅳ型患者转开腹手术。所有患者均未发生与内镜操作有关的严重并发症。术后1周经胆管造影后拔除ENBD管,其中1例胆总管有残留结石,予以ERCP取净结石。术后住院时间平均(9.8±1.5)d。随访15个月,1例反复发作胆管炎,并发现有胆管狭窄,予以ERCP下放置塑料内支架支撑数月后好转,余患者B超检查无胆管狭窄及结石复发。结论ERCP联合腹腔镜治疗Mirizzi综合征创伤小,疗效好,但各医院应根据自己的实力掌握好适应证,Ⅲ型、Ⅳ型患者开腹手术成功率高。

[ Objective ] To explore the application and superiority of endoscopic retrograde cholangiopancreatography （ERCP） and laparoscopy in the treatment of Mirizzi syndrome. [Methods] The clinical data of 18 patients with Mirizzi syndrome were analysed retrospectively. [Results] All the 18 cases with Mirizzi syndrome underwent first ERCP＋EST＋ENBD, and then laparoscopic treatment in stable condition; among which 10 cases of type Ⅰand 6 cases of type Ⅱ were successful, the success rate was 80 %, and other 1 case of type Ⅱ, 2 cases of type Ⅲ, 1 case of type Ⅳ converted to open surgery, laparotomy rate was 20%. There were no endoscopy-related serious complications in any patients. The tubes of ENBD were removed a week after operation. One case had residual common bile duct stones which were taken out through ERCP. The average length of hospital stay was （9.8±1.5） days. During 15-month follow-up in all the patients, cholangitis took place repeatedly in 1 case, and was followed by bile duct stricture which was cured after the plastic stent was placed through ERCP for a few months. [ Conclusions] ERCP and laparoscopy is worthy to apply to the general clinical treatment of Mirizzi syndrome because of the minor trauma and good effect, the success rate is high in the cases of type Ⅲ and type Ⅳ. But the indications should be correctly mastered in each hospital.