Mirizzi综合征外科诊治临床分析

Clinical Analysis of the Diagnosis and Surgical Treatment for the Mirizzi Syndrome

目的 探讨Mirizzi综合征的病因及临床特点 ,提高临床认识 ,避免术中胆道损伤。方法 对 2 3例Mirizzi综合征病人病历资料进行回顾性分析。结果 4例于术前明确诊断 ,确诊率 2 1.7%(4 / 2 3) ;术中确诊 18例。术中见胆囊管与肝总管平行走行者占 34.7% (8/ 2 3) ,胆囊管从后方或骑跨于肝总管者占 13.0 % (3/ 2 3)。 2例 (8.7% )术中未见结石存在。 2 3例均行手术治疗 ,术式包括保留胆囊颈的胆囊切除术 (15 / 2 3)或胆囊大部切除胆管壁修补T管引流 (5 / 2 3)和胆管空肠Roux -Y吻合术(3/ 2 3) ,术后无并发症发生。结论 Mirizzi综合征术前诊断困难 ,胆囊管解剖结构异常或结石嵌顿其必须病因 ;提高对Mirizzi综合征的病理认识 ,及时手术 。

Objective To explore the pathogenesis and clinical characters of Mirizzi syndrome , to improve the clinical knowledge about it ,and to avoid the damage of the bile duct. Methods Clinical data of 23 cases treated in our hospital were analyzed retrospectively. Results 4 of 23 cases got confirmed diagnosis preoperatively, which took 34.7% of all, the other 18 cases confirmed in operation. Patients whose cholecystic ducts paralleled the common hepatic duct took 34.7%(8/23) of all, whose cholecystic ducts went round from down or up of the common hepatic duct took 13.0%(3/23), 2 cases (8.7%) were found no stones. All the 23 patients were treated by operation, the form of which include routine operation in which cholecystic neck kept (14/23), subtotal cholecystectomy and T-tube drainage of the common bile duct operation (5/23), and Roux-en-Y hepatic jejunostomy operation.Conclusions It is difficult to get confirmed diagnosis before operation, cholecystic duct deformity or its stone and the obstruction is not the exclusive cause for the disease. Not only improving the realization of Mirizzi syndrome clinical characters, but operating in time and choosing the proper operation form according to the operational situation are the only way to cure the disease.