Mirizzi综合征的诊断及腹腔镜治疗的临床分析(附37例报告)

目的:探讨Mirizzi综合征的诊断及腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗Mirizzi综合征的价值及术中处理方法。方法:回顾分析1996年5月至2006年10月3651例LC术中37例Mirizzi综合征患者的临床资料。结果:37例中Ⅰ型30例,28例成功施行了LC或大部切除术,2例中转开腹;Ⅱ型5例,3例施行了腹腔镜胆囊大部切除,瘘口修补,胆总管切开胆道镜探查T管支撑引流术,2例中转开腹;Ⅲ型2例均中转开腹。术后发生胆漏3例均经引流痊愈。结论:B超是首选的检查方法,ERCP、MRCP能提高术前诊断率。腹腔镜及腹腔镜胆道镜联合应用能安全处理大部分Ⅰ型和Ⅱ型的Mirizzi综合征病例。

The clinical analysis of diagnosis and laparoscopic treatment 37 cases with Mirizzi syndrome

Objective:To evaluate the value of laparoscopic cholecystectomy(LC)and perioperative treatment for Mirizzi syndrome.Methods:Three thousand six hundred and fifty-one cases were performed LC from 1996 to 2006 in our hospital,and the clinical data of 37 cases with Mirizzi syndrome was analysis retrospectively.Results:There were 30 cases of type Ⅰ,5 cases of type Ⅱ,2 cases of type Ⅲ.28 cases of type Ⅰ were performed with LC or laparoscopic subtotal cholecystectomy successfully,3 cases of type Ⅱwere performed with laparoscopic subtotal cholecystectomy,repair of fistula,cholangiscopic exploration plus T tube placement drainage,2 cases of three types were converted to open laparotomy separately,3 cases with postoperative biliary leak were cured by drainage.Conclusions:BUS is the first choice of examination,MRCP and ERCP can improve the preoperative diagnostic rate.Laparoscopy plus cholangiscopy are effective and safe for type Ⅰ,type Ⅱ cases with Mirizzi syndrome.