Mirizzi综合征的临床诊断与治疗探讨分析

目的：探讨Mirizzi综合症的诊断治疗特点，以提高其诊断和治疗水平。方法：对35例经手术证实为Mirizzi综合症的临床资料进行回顾性分析。结果：35例Mirizzi综合症患者中仅4例（11．4％）术前确诊。Ⅰ型7例，Ⅱ型17例，Ⅲ型9例，Ⅳ型2例。5例行胆囊切除术，2例行胆囊大部分切除术；胆囊切除、胆囊瓣瘘口修补6例，12例行胆囊切除、胆总管探查、瘘口修补、T管引流术；胆囊切除、胆肠吻合术lO例。术后恢复好，随访结果，无严重并发症．结论：Mirizzi综合症术前确诊困难，B超结合MRCP／ERCP检查可以提高Mirizzi综合症的术前确诊率，手术容易损伤胆管，手术方式应据病理损伤程度决定。

Diagnosis and Treatment of Mirizzi Syndrome

Objective：To explore the characteristics of the diagnosis and treatment in patients with Mirizzi syndrome （MS） in order to improve the level of the diagnosis and treatment of MS. Methods： Thirty-five cases of MS proved by operation retrospectively analyzed. Results：The results revealed that the diagnosis before operation was made only in 4 cases （11.4%）. To differentiate the patterns of all patients by Csendes standard,pattern 1 for 7 cases,pattern Ⅱ for 17 cases,pattern Ⅲ for 9 cases,and pattern Ⅳ- for 2 cases. Of the 35 cases,5（14.3% ） were treated with choleeystecomy,2 （5.7 % ） with partial cholecystecomy, 6 （ 17.1 % ） were treated with cholecystecomy and eholedoehoplasty with remnant of the gallbladder, 12 （34.3%） were treated with cholecystecomy, choledochojejunostomy, repair of fistula and T tube drainage operations. Ten cases（28.6 % ）were treated with Roux-en-Y hepaticojejunostomy. All patients had complete re- covery after operations and no serious complications during the followup. Conclusion： MS is difficult to diagnose before operation. Preoperative diagnosis rate can be more improved by the way of taking ultrasonography first and then endo- scopic retrograde cholangio-pancreatography （ERCP） or magnetic resonance cholangio-pancreatography （MRCP） scanning. It＇s easy to damage the bile duct during operation. The surgical procedure must be chosen according to the pathological condition.