Mirizzi综合征39例微创治疗的临床分析

目的:探讨Mirizzi综合征的微创治疗方法及其疗效。方法:回顾分析2003年7月至2008年6月我院应用微创方法治疗39例Mirizzi综合征患者的临床资料。结果:按Csendes分类法,39例患者中I型26例,Ⅱ型8例,Ⅲ型4例,Ⅳ型1例。26例行腹腔镜胆囊切除术,8例行瘘口修补术,4例行胆囊壁翻转修补瘘口术,1例行Roux-en-Y肝总管空肠吻合术。中转开腹2例。术后5例发生并发症,均经非手术治疗痊愈。6例带"T"管出院。随访34例,随访时间1个月至5年,1例反复发生胆管炎,余情况良好。结论:在熟练掌握腹腔镜、十二指肠镜及胆道镜操作技术的前提下,微创治疗Mirizzi综合征是安全可行的,要针对不同的病例,采取个体化治疗方案。

The clinical analysis of minimally invasive treatment of 39 patients with Mirizzi syndrome

Objective:To explore the method and effect of treating Mirizzi syndrome with minimally invasive procedures.Methods:Clinical data of thirty-nine patients with Mirizzi syndrome who were treated with minimally invasive method from Jul.2003 to Jun.2008 were retrospectively analyzed.Results:According to the classification of Csendes,there were twenty-six cases of type I,eight cases of type Ⅱ,four cases of type Ⅲ and one case of type Ⅳ.Twenty-six patients were performed laparoscopic cholecystectomy,eight patients accepted direct suture of the orificium fistulae,four patients underwent repair of the orificium fistulae with the gallbladder valve,and one patient was treated by Roux-en-Y hepatojejunostomy.Two cases were converted to open surgery,postoperative complications were found in five cases(including biliary leakage in three cases,infection of incision in one case and frequent cholangitis in one case),and all of them were cured by non-surgical treatment.Six of them discharged with T tube.Thirty-four cases were followed up from one month to five years.Among them,cholangitis occurred only in one case frequently,while others were satisfactory.Conclusions:Minimally invasive treatment of Mirizzi syndrome is feasible and safe with proficient laparoscopic and endoscopic skill.The treatment plan should individualize for different patients.