Mirizzi综合征非周径性胆管缺损的修复及手术策略

Surgical strategy to repair non-circumferential defect of bile duct in Mirizzi syndrome

目的评价手术修复Mirizzi综合征非周径性胆管缺损的疗效。方法回顾性分析手术修复Mirizzi综合征非周径性胆管缺损32例临床资料，总结采用不同的自身材料修复胆管缺损的治疗效果。结果本组32例手术均成功完成，无手术死亡。其中带蒂胆囊瓣修复胆管缺损25例，带蒂脐静脉瓣修复胆管缺损5例，带蒂大网膜瓣修复胆管缺损2例。术后并发症2例。其中脐静脉瓣修复胆管缺损术后胆漏1例，经引流管引流胆汁，术后7d无胆汁引出，拔除引流管；胆管残余结石1例，术后9个月后经T管窦道胆道镜取出结石。所有病例均在术后9～12个月经T管胆道造影，无结石或胆管狭窄等异常后拔除T管。全部病例均得到随访，随访时间1～5年。全部病例均无胆管狭窄或腹痛、黄疸、发热等胆管炎症状发生。结论采用自身材料如带蒂胆囊瓣、脐静脉瓣及大网膜瓣手术修复Mirizzi综合征胆管缺损的疗效确切，是外科治疗的最佳选择。

Objective To evaluate the efficacy of surgical repair for non-circumferential defect of bile duet in Mirizzi syndrome. Method The clinical data of 32 patients with Mirizzi syndrome with non-circumferential defect of bile duct were repaired using the patient＇s own tissues such as gallbladder pedicle flap, umbilical venous flap and omental flap. Results All the patients were operated success- fully. There was no operative mortality. The defects in the bile duct were repaired using gallbladder pedicle flap in 25 patients, umbilical venous flap in 5 patients and omental flap in 2 patients. There were 2 patients who developed postoperative complications. There was one postoperative bile leakage in a patient who was repaired using an umbilical venous flap. The other complication was residual bile duct stones. The patient with postoperative bile leakage was drained through a drainage tube which was removed after 7 days. The residual bile duct stones were removed by endoscopy through a T-tube sinus after 9 months. All patients were confirmed by Ttube cholangiography after 9 to 12 months to have no stones, bile duct stenosis or any other abnormalities. The T-tube was then removed. All pa- tients were followed-up for 1 to 5 years. All patients had no cholangitis, abdominal pain, jaundice or fever. Conclusions Using the patients＇ own tissues such as gallbladder pedicle flap, umbilical venous flap and omental flap to surgical repair the defect in the bile duct of patients with Mirizzi syndrome was effective. This surgical treatment is a good choice.