微创治疗Mirizzi综合征

Laparoscopy and endoscopy in treating Mirizzi syndrome

目的 :综合利用腹腔镜、十二指肠镜、胆道镜 ,探索微创治疗Ⅱ型、Ⅲ型Mirizzi综合征的方法。方法 :治疗Ⅱ型、Ⅲ型Mirizzi综合征 2 1例 ,先经十二指肠镜行ERCP及ENBD治疗 ,后行腹腔镜胆总管探查、取石及胆总管或肝总管缺损修补术 ,术中胆道镜检查 ,不放置T管。结果 :2 1例中微创手术成功 19例 ,中转开腹 2例。无严重并发症及死亡病例。术后住院时间明显缩短 ,但手术时间较开腹手术长。部分病例随访半年以上未见远期并发症。结论 :利用多种内镜、腹腔镜手段治疗Mirizzi综合征在技术上切实可行、安全可靠。但腹腔镜下的缝合胆管缺损较困难 。

Objective:To explore the method of applying combined endoscopy and laparoscopy to treat Csendes's Ⅱ,Ⅲ Mirizzi Syndrome.Methods:21 patients were admitted the therapeutical procedures, i.e. they were done endoscopic nasobiliary drainage(ENBD)first,then laparoscopic common bile duct exploration(LCBDE), extraction of stones, operational choledochoscopy and directly suture the defect bile duct without T tube.Results: 19 cases were operated successfully,2 cases were converted to open operation;neither residual stones, nor serious complications were observed. The time taken for the endoscopy was remaining longer than open operation, while postoperative hospitalization period of the former shortened obviously than that of the latter. None of the complications could be traced after follow up for 6 15 months.Conclusions:The combined laparoscopy and endoscopy is practicable and safe in the hands of skillful endoscopists. Suture the defect bile duct is difficult and this programe is able to substitute some open operation.