腹腔镜手术治疗Mirizzi综合征的临床研究

Clinical study of laparoscopic surgery for Mirizzi syndrome

目的探讨腹腔镜手术治疗Mirizzi综合征的临床疗效。方法对1997年2月￣2009年6月经腹腔镜手术证实的72例Mirizzi综合征患者的临床资料进行回顾性分析。其中,术前确诊33例(术前组),术中诊断39例(术中组),比较两组患者的腹腔镜手术并发症发生率。结果结合术中情况,确定为Ⅰ型41例,Ⅱ型27例,Ⅲ型3例,Ⅳ型1例。腹腔镜手术治疗66例,手术包括胆囊切除术41例,胆囊大部切除术25例。Ⅱ型患者中,16例一期缝合修复瘘口,10例用胆囊组织覆盖修复瘘口。中转开腹6例,其中Ⅰ、Ⅱ型各1例,Ⅲ型3例,Ⅳ型1例。在66例行腹腔镜手术治疗的患者中,术后肺部感染者5例,泌尿系感染者3例,胆漏2例,均痊愈出院。术前组和术中组并发症的发生率分别为9.7%和20.0%(P<0.05)。术后随访6～20个月,无胆道狭窄和结石残留等并发症。结论腹腔镜手术治疗Mirizzi综合征Ⅰ、Ⅱ型安全、有效及并发症少,且术前明确诊断可以降低并发症的发生率,提高腹腔镜手术的疗效。

【Objective】 To explore the clinical effects of laparoscopic surgery for Mirizzi Syndrome.【Methods】 The clinical data of 72 cases with Mirizzi syndrome who were confirmed by laparoscopic surgery was retrospectively studied from Feb.1997 to Jun.2009,including 33cases diagnosed preoperatively（preoperative group） and 39 cases diagnosed intraoperatively（intraoperative group）.The complication rates of laparoscopic surgery were compared between the two groups.【Results】 Combination of introperative conditions,41 cases were identified as type Ⅰ,27 cases were typeⅡ,3 cases were type Ⅲ and 1 cases were type Ⅳ.66 cases received laparoscopic surgery,including cholecystectomies in 41 cases,subtotal cholecystectomies in 25 cases,in type Ⅱ,16 cases received primarily suture and repair,10 cases received choledochoplasty with cuff of the gallbladder;6 cases were converted to open surgery,including 1 case with type Ⅰ,1 case with type Ⅱ and all cases with type Ⅲ and Ⅳ.The postoperative recovery was smooth except that 5 cases had pulmonary infection,2 cases had bile leakage and 3 cases had urinary infection.Among the 66 cases received laparoscopic surgery,the complication rates of preoperative group and intraoperative group were 9.7% and 20% respectively（P 0.05）.During a follow-up of 6~20 months for all cases,there were no biliary stricture and residual stones.【Conclusion】 Laparoscopic surgery for Mirizzi syndrome ⅠandⅡtype is safe and effective with less complication.Definitely preoperative diagnose can reduce the incidence of complication and improve the curative effect of laparoscopic surgery.