三镜联合治疗Mirizzi综合征的临床体会

Clinical experience of combined use of laparoscopy,choledochoscopy and duodenoscopy for Mirizzi syndrome

目的:探讨三镜联合治疗Mirizzi综合征的临床价值。方法:回顾分析2012年3月至2017年3月收治的25例Mirizzi综合征患者的临床资料,其中11例行腹腔镜、胆道镜治疗(A组),14例行十二指肠镜、腹腔镜、胆道镜三镜联合治疗(B组),按Csendes分型,两组患者为Ⅱ型、Ⅲ型Mirizzi综合征,对比分析两组疗效。结果:手术均获成功,无一例中转开腹。两组术中出血量[(47.2±22.1)ml vs.(53.3±17.3)ml]、术后腹腔引流时间[(3.4±0.6)d vs.(3.7±0.8)d]差异无统计学意义(P>0.05);B组手术时间[(183.2±24.6)min vs.(123.5±17.6)min]、术后总并发症发生率(27.3%vs.0)、术后住院时间[(8.8±2.7)d vs.(6.3±1.5)d]、患者满意度评分[(81.1±7.2)vs.(95.3±4.3)]优于A组,差异有统计学意义(P<0.05)。结论:三镜联合治疗Ⅱ型、Ⅲ型Mirizzi综合征具有安全、患者创伤小、术后康复快、术后并发症少等优势。

Objective：To study the clinical value of combined use of laparoscopy,choledochoscopy and duodenoscopy for Mirizzi syndrome. Methods：Clinical data of 25 patients with Mirizzi syndrome from Mar. 2012 to Mar. 2017 were retrospectively analyzed,11 patients underwent laparoscopy and choledochoscopy in Group A,and 14 patients underwent laparoscopy,choledochoscopy and duodenoscopy in Group B. According to Csendes standard,two groups were Mirizzi syndrome types Ⅱ and Ⅲ. The therapeutic effect of the two groups were comparatively analyzed. Results：All the patients were successfully operated under laparoscopy without conversion to laparotomy. There was no significant difference between two groups in the intraoperative blood loss [（ 47. 2 ± 22. 1） ml vs.（ 53. 3 ±17. 3） ml],the postoperative abdominal drainage time [（3. 4 ± 0. 6） d vs.（3. 7 ± 0. 8） d]. The Group B was superior over the Group A in operation time [（183. 2 ± 24. 6） min vs.（123. 5 ± 17. 6） min],the incidence of postoperative complications（27. 3% vs. 0）,the postoperative hospital stay [（8. 8 ± 2. 7） d vs.（6. 3 ± 1. 5） d] and the satisfaction scores of the patients [（81. 1 ± 7. 2） vs.（95. 3 ±4. 3）]. Conclusions：In the treatment of Mirizzi syndrome type Ⅱ and Ⅲ,combined use of laparoscopy,choledochoscopy and duodenoscopy has obvious advantages for operation safety,mini-invasion,quick recovery and few complications.