Mirizzi综合征22例诊治探讨

目的 探讨Mirizzi综合征的临床表现、影像特点、诊断及治疗。方法 回顾性分析22例经手术证实的Mirizzi综合征患者，结果 22例经手术证实的患者中，术前明确诊断者5例（22.7%)，可疑6例（27.3%)，其余均经手术而确诊，其中同时伴胃瘘、十二指肠瘘各1例。22例均经手术治愈，无死亡，其中胆囊切除9例，胆囊大部切除5例，胆囊（部分）切除、胆管瘘修补、T管支撑引流4例，胆囊切除、肝总管空肠Roux-en-Y吻合3例，1例行胆囊切除、胆总管端端吻合、T管支撑引流术。全组胆管损伤2例，占9.1%。结论 对Mirizzi综合征提高术前诊断率尤为重要，影像学方法对该病有较大帮助，如术前术中证实该病，术中要仔细操作，对不同情况采取不同术式，避免胆管损伤。

Diagnosis and treatment of Mirizzi syndrome(a report of 22 cases)

Objective To explore the clinical manifestations,imaging features,diagnosis and treatment of Mirrizi syndrome. Method Twenty two patients with Mirizzi syndrome proved by operation were retrospectively analyzed. Results Five cases were diagnosed(22.7%), 6 cases were suspected(27.3%) and the others were misdiagnosed prior to operation(50%). One case was accompanied with gastric fistula and 1 with duodenal fistula. Of 22 patients, 9 were treated with cholecystectomy, 5 with partial cholecystectomy, 4 with cholecystectomy,neoplasty of the fistula and T tube drainage, 3 with cholecystectomy and Roux en Y hepaticojejunostomy, and one with cholecystectomy,end to end anastomosis of common biliary duct and T tube drainage. However,biliary duct injury occurred in 2 cases(9.1%). Conclusion It is very important to improve diagnosis rate for Mirizzi syndrome. These findings suggest that the diagnosis rate can be improved by sonography first and then endoscopic retrograde cholangio pancreatography(ERCP). The different surgical precedure should be adopted individually.