Mirizzi综合征37例临床分析

Clinical features of 37 patients with Mirizzi Syndrome

目的总结Mirizzi综合征的病理特征、诊断及治疗方法，以提高该病的诊疗效果。方法对手术前或手术中证实的37例Mirizzi综合征患者的临床资料进行回顾性分析。结果37例Mirizzi综合征术前明确诊断15例，行胆囊切除10例。胆囊切除＋胆总管探查＋T管引流11例；胆囊切除＋胆管探查＋胆管修补＋T管引流9例；肝总管空肠Roux-en-Y式吻合术3例；行腹腔镜胆囊切除术4例，1例因胆囊三角粘连严重中转开腹。术后出现胆瘘1例。所有患者均痊愈出院。结论B型超声、磁共振胰胆管造影术、经内镜逆行胰胆管造影术是Mirizzi综合征诊断的主要手段；Mirizzi综合征病理类型不一，手术方式应根据具体病理分型来决定。

Objective To summarize the pathological features, methods of diagnosis and treatment of Mirizzi Syndrome to improve the outcomes of diagnosis and treatment. Methods Pre-operative and intraoperative data from 37 patients with Mirizzi Syndrome were retrospectively analyzed. Results Fifteen of the 37 patients were diagnosed with Mirizze Syndrome definitely before operation, among whom 10 were given cholecystectomy. Another 11 patients were treated with cholecystectomy ＋ common bile duct exploration ＋ T tube drainage,9 with cholecystectomy ＋ bile duct exploration and repair ＋ T tube drainage. 3 with hepatic ductjejunum Roux-en-Y anastomosis;4 with cholecystectomy under laparoscope among whom 1 patients received routine abdominal surgical after failure of microscopical cholecystectomy for severe adhesion. One patients experienced complication of biliary fistula. All the patients were cured and left hospital. Conclusion Type-B ultrasound, magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography are major measures which can be comprehensively used for the diagnosis of Mirizzi Syndrome. Mirizzi Syndrome is heterogenous in the pathological features on which the surgical procedures should be based on.