腹腔镜胆囊切除术围手术期Mirizzi综合征的诊断、治疗及疗效评价

Diagnosis,treatment,and outcome of Mirizzi syndrome in the perioperative period of laparoscopic cholecystectomy

目的探讨腹腔镜下Mirizzi综合征的诊断、术中处理方法及疗效评价。方法回顾性分析解放军第四五一医院2006年12月-2014年12月行腹腔镜胆囊切除术(LC)时围手术期内发现的Mirizzi综合征32例,总结术中诊断、术式选择和疗效评价。结果32例Mirizzi综合征,术前诊断8例,余均为LC术中诊断。按Csendes分型,Ⅰ型23例,Ⅱ型7例,Ⅲ型1例,Ⅳ型1例。30例完成LC手术,分别为Ⅰ型(23例)和Ⅱ型(7例)。1例Ⅱ型患者于腹腔镜下行胆囊切除术+胆总管探查术。2例患者中转开腹,分别为Ⅲ型(1例)和Ⅳ型(1例)。Ⅲ型患者行胆管端端吻合术,Ⅳ型患者行胆肠吻合术。结论 Mirizzi综合征诊断困难,B超是首选检查方法,结合磁共振胰胆管造影和经内镜逆行胰胆管造影可提高术前诊断率。多数Ⅰ型和Ⅱ型可在腹腔镜下完成手术,对于Ⅲ型和Ⅳ型,应尽量开腹手术,避免损伤胆道。

Objective To investigate the diagnosis,treatment,and outcome of Mirizzi syndrome in patients undergoing laparoscopic cholecystectomy（ LC）. Methods A retrospective analysis was performed on the clinical data of 32 patients who underwent LC in the 451 Hospital of PLA from December 2006 to December 2014 and experienced Mirizzi syndrome during the perioperative period. Intraoperative diagnosis,selection of surgical procedures,and evaluation of treatment outcome were summarized. Results Among these patients with Mirizzi syndrome,8 were diagnosed before surgery and 24 were diagnosed during LC. According to the Csendes classification,23 patients had type Ⅰ,7 had type Ⅱ,1 had type Ⅲ,and 1 had type Ⅳ Mirizzi syndrome. A total of 30 patients completed LC,and they all had type I or Ⅱ Mirizzi syndrome. One patient with type Ⅱ disease underwent LC and common bile duct exploration. Two patients with type Ⅲ or Ⅳ disease were converted to open surgery; the type Ⅲ patient underwent bile duct end- to- end anastomosis,and the type Ⅳ patient underwent choledochoenterostomy. Conclusion Mirizzi syndrome is difficult to diagnose,and ultrasonography is the preferred method of examination. A combination of magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography can improve preoperative diagnostic rate. Most cases of type Ⅰ and Ⅱ Mirizzi syndrome can be treated by LC. Open surgery should be considered for type Ⅲ and Ⅳ cases to avoid biliary tract injury.