老年Mirizzi综合征的手术处理

Operative Management of Mirizzi Syndrome in Aged Patients

目的 探讨老年胆囊结石并发Mirizzi综合征手术时处理不当所致严重并发症的原因及手术治疗方法。方法 对 12例老年Mirizzi综合征病人术中处理经验进行回顾性分析。 结果 Ⅰ型 6例 ,Ⅱ型 3例 ,Ⅲ型 1例 ,Ⅳ型 2例。一次性完成手术 11例 ,除 1例附加胆肠内引流外其余 10例采用胆囊切除、次全切除、胆囊肝总管瘘修补等简单术式。另 1例采用二次分次手术行胆肠内引流。临床痊愈 11例 ,死亡 1例。 结论 ①对病程长 ,多年反复发作的胆囊结石并发不同程度的梗阻性黄疸和胆管炎者应考虑本症 ;②老年胆囊壁胶原纤维增加、增厚 ,弹性差 ,排空慢 ,胆汁淤积 ,结石嵌顿易继发感染粘连 ,手术时如处理不当易致严重的并发症 ,应引起重视 ;③炎症粘连严重者不强求切除胆囊 ,可在取净结石的前提下行保留颈部的胆囊部分切除 ,一般取出结石 ,受压的肝总管即可自行复原。

Objective To study the proper procedure and the causes of the complications due to improper treatment for Mirizzi syndrome in aged patients during operation. Methods Twelve old patients with Mirizzi syndrome were reviewed. Results In this group 6 cases were type Ⅰ,3 were type Ⅱ, 1 was type Ⅲ and 2 were type Ⅳ according to anatomical classification. All patient were treated with proper surgery at one time except one who underwent second operation of choledochoenterostomy. Eleven patients were cured and one died.Conclusions ①Mirizzi syndrome should be considered when obstructive jaundice occured in patients with a long history of symptomatic gallbladder stones. ②Great attention must be paid to the aged patients with Mirizzi syndrome during operation, otherwise serious complications may result from improper handling of the inflammatory adhesion of the thickened gallbladder wall. ③In case of extensive adhesion, a partial cholecystectomy with the cystic duct in situ may be the safest alternative. The compression of the common duct will be released after romoval of stone.