Mirizzi综合征诊断与处理对策(附27例报告)

目的 总结Mirizzi综合征(MS)的诊断与处理经验，以供同道借鉴。方法 对27例经手术证实的MS的临床资料进行回顾性分析，结合文献，对该病的病因、特点及诊断与处理做一探讨。结果27例中术前确诊4例。在腹腔镜手术中发现MS4例，中转开腹1例。根据病理损伤程度，术中分别采用了胆囊切除术、胆囊大部分切除术、瘘口直接修补术、带血管蒂胆囊瓣修补痿口术及Rour-en-Y胆肠吻合术等手术治疗，术后患者全部临床治愈。结论 MS术前诊断较困难，确诊率低，提高对本病的认识有重要的意义。对不同病理类型的MS应采取不同的手术方法。腹腔镜下治疗MS是可行的。

Diagnosis and treatment of Mirizzi syndrome (a report of 27 cases)

[Objective] To summarize experience of diagnosis and treatment of MS. [Methods] 27 patients with MS testified through operation were analyzed retro- spectively and cause, characteristic, diagnosis and treatment of MS were discussed by our experience and domestic and foreign literature. [Results] Only 4 cases were diagnosed preoperatively. 4 cases were diagnosed during the LC, in which 1 case was inverted into open abdomen operation. On the basis of pathological injury degree, variant operative methods were adopted such as cholecystectomy, subtotal cholecystectomy, direct repair of biliary duct fistula, repair of bile duct fistula with vascularized gallbladder graft, Roux-en-Y cholangiojejunostomy. All the patients were cured after the operation. [Conclusion] Diagnosis of MS preoperatively is very difficult, and rate of final diagnosis is low. So it is very important to enhance recognition about this special disease. Different operative procedures should be used according to patients' pathologic type. It is feasible to treat MS through laparoscopic surgery.