37例Mirizzi综合征腹腔镜诊疗体会

Experience of laparoscopic diagnosis and treatment of Mirizzi syndrome in 37 cases

目的探讨Mirizzi综合征的诊断及腹腔镜手术治疗方法。方法回顾性分析我院2002年1月~2016年12月术前及术中诊断为Mirizzi综合征患者的临床资料。结果 Mirizzi综合征患者共37例,其中Ⅰ型28例,18例行腹腔镜胆囊切除术,7例行腹腔镜胆囊次全切除术,3例因粘连严重或胆道损伤中转开腹手术;Ⅱ型8例,5例行腹腔镜胆囊次全切除+瘘口修补术,1例行腹腔镜胆总管切开取石+胆囊次全切除+瘘口修补+T管引流术(T管跨过瘘口部位),2例因肝总管损伤中转开腹手术;Ⅲ型1例,因肝总管瘘口过大中转开腹行胆囊空肠Roux-en-Y吻合术;无Ⅳ型病例。结论对可疑Mirizzi综合征患者,应完善术前检查以明确诊断。对于Ⅰ型和部分Ⅱ型患者腹腔镜手术是安全可行的,对局部粘连严重或瘘口过大的部分Ⅱ型、Ⅲ型和Ⅳ型患者宜采用传统开腹手术治疗。

Objective To explore the diagnosis of Mirizzi syndrome and the treatment by laparoscopic surgery.Methods The clinical data of Mirizzi syndrome patients who were diagnosed before or during the surgery from January 2002 to December 2016 in our hospital were retrospectively analyzed.Results A total of 37 patients with Mirizzi syndrome were enrolled including type Ⅰ（n=28）,type Ⅱ（n=8）,and type Ⅲ（n=1）.No type Ⅳcase was involved in this study.Among typeⅠ,18 patients were performed with laparoscopic cholecystectomy,7 with laparoscopic sub-total cholecystectomy,and the rest 3 patients were converted to laparotomy due to severe adhesion or biliary injury.Among type Ⅱ,5 patients were performed with laparoscopic sub-total cholecystectomy ＋fistula repair,1 with the combination of laparoscopic choledocholithotomy＋sub-total cholecystectomy＋fistula repair＋T tube drainage（T tube across the fistula site）,and the remaining2 were converted to laparotomy due to common hepatic duct injury.Among type Ⅲ,the patient was converted to cholecystojejunostomy（Roux-en-Y） by laparotomy due to large common hepatic duct fistula.Conclusion For patients with suspected Mirizzi syndrome,preoperative examination should be performed to confirm the diagnosis.Laparoscopic surgery is safe and feasible for typeⅠ and partial typeⅡ patients,but for patients with type Ⅱin severe local adhesion or large fistula,Ⅲand Ⅳ,laparotomy is an optimal choice.