微创技术在Mirrizi综合征诊治中的应用体会

目的：评价微创技术对Mirizzi综合征的诊断和治疗效果。方法：对2009年1月~2013年4月期间证实为Mirizzi综合征的28例患者临床资料进行回顾性分析。28例中Ⅰ型12例（42.9%）,Ⅱ型8例（28.6%）,Ⅲ型6例（21.4%）,Ⅳ型2例（7.1%）。所有病人术前常规行磁共振胰胆管成像（MRCP）检查,必要时行经内镜逆行胰胆管造影（ERCP）检查。结果：28例Mirizzi综合征患者中,其中11例Ⅰ型患者均成功采用经腹腔镜胆囊切除术,Ⅱ型8例中5例行腹腔镜胆囊切除术,3例中转开腹。Ⅲ型和Ⅳ型共10例中7例行开腹手术,2例行三镜联合手术,1例因高龄、体质差,仅行内镜下支架引流术。结论：胆道外科进入微创时代,对部分Mirrizi综合征患者,通过多种微创技术的联合应用,可以达到较好的临床效果。

Application of minimally invasive techniques in diagnosis and treatment of Mirrizi syndrome

Objective; To evaluate the application of minimally invasive techniques in diagnosis and treatment of Mirizzi syndrome effects. Methods： From January 2008 to April 2013, clinical date of 28 patients confirmed as Mirizzi syndrome were retrospectively analyzed, including 12 patients with Ⅰ type （42.9%）, 8 patients with type Ⅱ （28.6%）, 6 patients with III type （21.4%）, and 2 patients with IV type （7.1%）. All patients underwent preoperative routine MRCP examination, and ERCP examination if necessary. Results.. A total of 11 cases with type Ⅰ had successful laparoscopic cholecystectomy, 5 patients of type Ⅱ underwent laparoscopic cholecystectomy, 3 patients of type Ⅱ had laparotomy. Seven patients with type Ⅲ and IV had open surgery, 2 patients with type Ⅲ and IV had endoscopic surgery, and one case had only endoscopic stent drainage because of age and poor health. Conclusions： Combination of a variety of minimally invasive techniques is effective on treating Mirrizi syndrome.