单中心Mirizzi综合征诊治经验

Diagnosis and treatment of Mirizzi syndrome： a single-centre experience

目的探讨Mirizzi综合征的诊断和手术治疗。方法回顾2001年7月至2011年7月接受治疗的Mirizzi综合征患者的临床资料，并对其诊断方法、手术方式及治疗结果进行分析。结果13800例胆囊切除术中共诊断Mirizzi综合征56例（0．4％），其中有30例术前得以诊断，占53．6％。根据Csendes分型，Mirizzi综合征Ⅰ型29例、Ⅱ型17例、Ⅲ型9例、Ⅳ型1例，其中有2例合并胆囊癌（3．6％）。本组有33例采用腹腔镜手术，其中16例中转开腹，其余患者行开腹手术。手术方式包括胆囊切除术，胆总管探查、T管引流术，瘘口直接修补、T管引流术，肝总管空肠Roux-en—Y吻合术及胆囊癌根治性切除、肝管空肠吻合术。2例行腹腔镜下手术时发生胆管损伤，术前均未疑及Mirizzi综合征。术后并发症包括胆总管残留结石2例，胆漏4例。所有患者均痊愈出院，无围手术期死亡病例。结论尽管有多种影像学检查可供选择，Mirizzi综合征的术前诊断仍是一个挑战。开腹手术是其标准治疗方式，而腹腔镜手术可适用部分患者，特别是Mirizzi综合征Ⅰ型患者。Mirizzi综合征的治疗应根据术中探查及其病理分型采用不同的手术方式。

Objective To study the diagnosis and surgical treatment of Mirizzi syndrome （MS）. Method The clinical data of patients with Mirizzi syndrome treated in our center from July 2001 to July 2011 were retrospectively studied and the diagnostic methods, operative strategies and outcomes of surgical treatment were analyzed. Results Mirizzi syndrome （MS） was identified in 56 out of 13800 patients who received cholecystectomy （0.4%）. MS was diagnosed preoperatively in 30 patients （53.6%）. There were 29 patients with Mirizzi syndrome type I , 17 patients with type Ⅱ , 9 patients with type Ⅲ, and 1 patient with type Ⅳ using the Csendes＇s classification. In two patients （3.6 %） co- incidental gallbladder carcinoma was detected. An initial laparoscopic approach was attempted in 33 patients, and 16 were converted to open surgery. The remaining 23 patients underwent open opera- tion. Surgical procedures included cholecystectomy, choledochotomy and T-tube insertion, simple clo- sure and drainage （via T-tube） of the biliary fistula, Roux-en-Y hepaticojejunostomy, radical resection of gallbladder and hepaticojejunostomy. Inadvertent bile duct injury occurred in 2 patients who had an initial laparoscopic approach for a preoperative undiagnosed MS. Postoperative morbidities included biliary leak （n= 4） and residual common bile duct stone （n： 2）. All patients recovered completely and there was no hospital mortality. Conclusions Preoperative diagnosis of Mirizzi syndrome is still chal- lenging despite the availability of multiple imaging modalities. Open surgery remains the standard of care, although laparoscopic treatment may be used in selected patients, especially for type I Mirizzi syndrome. Patients with Mirizzi syndrome should be managed differently, basing on intraoperative findings and the type of Mirizzi syndrome.