Mirizzi综合征诊治探讨

To Comprehend the Mirizzi’s Syndrome In Diagnosis and Treatment

目的探讨Mirizzi综合征病人的诊断和外科治疗的手术方式。方法回顾性分析我院自2002-2012年间治疗的24名Mirizzi综合征患者,在临床症状、实验室检查、术前评估、术中探查发现、是否合并胆总管结石、不同的类型的手术操作和术后的并发症进行了分析。结果最常见的症状为腹部疼痛(100%)和黄疸(91.67%),所有患者肝功能均有改变。术前明确诊断有2例(8.33%),术中明确诊断有22例(91.67%)。胆囊肝总管瘘伴胆总管结石2例(8.33%)。CsendesⅠ型患者18例(75%),Ⅱ型4例(16.67%),Ⅲ型1例(4.17%)和Ⅳ型1例(4.17%)。单纯胆囊切除术进行18例(75%)。2(8.33%)例行胆囊切除+瘘孔关闭+T管引流术,2(8.33%)例行胆囊切除+胆囊瓣修补+T管引流术。2例(8.33%)行胆囊切除术+肝总管空肠吻合术(Roux-en-y)。23例(95.83%)完全恢复出院;1例出现胆漏,充分引流后出院。结论 Mirizzi综合征治疗成功的关键在于术前的认真准备和完善的检查,甚至在手术时,对每一例患者进行个体化治疗。

Objectives To explore diagnosis and treatment of the cholecystolithiasis complicated Mirizzi＇ s syndrome. Methods Retrospective analysis of our hospital in 2002 - 2012 a total of 24 cases of Mirizzi, s syndrome The following items were evaluated ： clinical presentation, laboratory results, preoperative evaluation, operative findings, presence of choledocholithiasis, type of Mirizzi syndrome according to the classification by Csendes, choice of operative procedures and complications. Results The most frequent symptoms were abdominal pain （ 100% ） and jaundice （91.67%）. All the patients presented altered hepatic function tests. The diagnosis of Mirizzi syndrome was intraoperative in 22 （91.67%） patients, and preoperative in 2 （8.33%）. Cholecystocholedochal fistula associated with choledocholithiasis was observed in 2 （8.33%） cases. Mirizzi syndrome was classified as Csendes type Ⅰ in 18 （75%） patients, type Ⅱ in4 （16. 67% ）, type Ⅲin1 （4. 17% ） and type Ⅳin another （4.17%）. Cholecystectomy, as an isolated surgical procedure, was performed in 18 （75%） patients, a direct orificium fistulae repair ＋ T-tube drainage in 2 （8. 33% ） cases; gallbladder neck flap patch ＋ T-tube drainage in 2 （ 8.33% ） patients ;2 （ 8.33% ） patients were submitted to cholecystectomy and s/de- to-side choledochojejunostomy（Roux-en-y）. 23 （95.83%）patients had an uneventful recovery, only 1 case of biliary fistula was discharged after complication by abdominal drainage. Conclusion The success of the treatment is related to a precocious recognition of the condition, even at the time of surgery, and adapting the management considering to the individual characteristics of each case.