38例Mirizzi综合征的临床诊治分析

Experience in diagnosis and treatment of 38 cases with Mrizzi syndrome

目的探讨Mirizzi综合征的病理特点、诊断和治疗方法,提高该病的诊治水平。方法对38例Mirizzi综合征患者的临床资料进行回顾分析。结果38例Mirizzi综合征患者10例(20.31%)术前诊断明确,本组无手术后死亡病例;1例I型患者胆囊切除术后出现胆漏;1例胆囊切除+瘘口修补+T管引流术后10个月再次出现胆总管狭窄;1例IV型患者行胆囊切除+胆肠Roux-en-Y吻合术后5年再发肝内胆管结石并感染;38例中12例行腹腔镜下胆囊切除术(LC),4例由于腹腔镜手术中解剖困难、出血中转开腹。结论手术前诊断及术中注意Mirizzi综合征的存在能降低手术胆道损伤率。

Objective To explore the characteristics of the diagnosis and treatment and pathology in patients with Mirizzi syndrome（MS） to improve the level of the diagnosis andtreatment of MS. Methods We performed a retrospective analysis of the clinic cases of 38 patients with Mrizzi syndrome. Results In these 38 cases,Mirizzi syndrome were found in 1（020.31%） before surgery,there were no patients dead after surgery.1 patient who was proved to be I type occure bile leakage after cholecystectomy,1 patient who was proved to be Ⅳ type reoccure hepatolithiasis after performed cholecystectomy and Roux-en-Y Anastomosis,1 patient who performed cholecystectomy and the bile duct repaire and T-tube drainaged occurred postoperative biliary stricture.An initial laparoscopic approach was attempted in 38 patients,of whom 12 were converted to open procedures.Conclusions Preoperative diagnosis and precise operation in intraoperative were efficient to decrease the risk of bile duct injury.