Mirizzi综合征的手术对策

目的Mirizzi综合征（MS）是胆石症少见的一种并发症,探讨外科治疗MS的策略,尽量减少手术损伤。方法收集我院2003年至2008年手术治疗的36例MS病例,回顾分析术前处理、手术方式选择、术后并发症及预后情况。结果本组患者均经腹腔镜或开腹手术证实,Ⅰ型23例,Ⅱ型11例,Ⅲ型2例。20例术前行鼻胆管引流术。所有手术均行大部分胆囊切除,MSⅠ型行胆囊管直接缝扎;MSⅡ型行残留胆囊壁对缝或通过瘘口胆总管内置＂T＂管引流;MSⅢ型行部分壶腹壁贴附肝胆管缺损处进行修补或肝胆管空肠吻合。本组无一例胆管损伤及严重腹腔感染,均痊愈出院,随访6-36个月,预后良好。结论无论行腹腔镜还是开腹手术治疗Mirizzi综合征,都要以最小的手术创伤获得最佳的治疗效果,减少手术并发症,使患者尽快康复。

Treatment of surgical Mirizzi syndrome

Objective To explore the strategy of surgical method and reduce the surgical injury in the treatment of Mirrizzi syndrome（MS）,which is a rare complication of cholelithiasis.Methods retrospective in our hospital from 2003 to 2008,including preoperative treatment,surgical options,postoperative complications and prognosiswere anayzed.Results Confirmed under laparoscopic or open surgery,23 cases were type Ⅰ,11 cases were type Ⅱ,2 cases were type Ⅲ.20 cases were carried out nasal preoperative biliary drainage.All operations were performed cholecystectomy.Type Ⅰof MS were performed cystic duct direct suturing,and type Ⅱof MS were performed residual gallbladder wall suturing oppositely or drainage through ＂T＂-tube built through the common bile duct fistula.Type Ⅲ were treated by repairing pot wall defect with attached part of the bile duct or biliary jejunostomy.No bile duct injury or severe abdominal infection were observed in this group and all the cases were cured.A good prognosis were observed during 6-36 months of follow-up.Conclusion The best therapeutic effect with minimal surgical trauma,reduced surgical complications and fast recovery were achieved applying laparoscopy or laparotomy in the treatment of MS.