Mirizzi综合征的诊治体会

目的：提高对Mirizzi综合征的认识，进一步探讨该病诊治特点。方法：回顾性分析并随访自1990－1998年7月间收治的26例Mirizzi综合征。结果：全部病例均经手术证实。术中发现15例存在肝大。术后2例发生胆瘘，经保守治疗痊愈。1例术后进行性黄疸加重死于肝肾功能衰竭，另1例胆囊颈组织癌变，术后8个月肿瘤转移死亡，其余病例随访3年，治疗效果满意，无胆道系统的并发症。结论：对病史长、反复发作的胆囊结石患者，尤其合并梗阻性黄疸者，尤应考虑到Mirizzi综合征。结合各种影像学检查，术前多数能够确诊。根据病理解剖类型采取相应的手术治疗方法，分别或联合应用胆囊逆行切除和部分切除、避免过多解剖Calot三角是一安全有效的治疗手段，能够降低术后并发症。T管应该放置在瘘口的远端胆管内。

Diagnosis and management of the Mirizzi syndrome

Objective:To study the diagnosis and treatment of Mirizzi syndrome(MS).Methods:The 26 patients with MS were retrospectively reviewed and followed up.Results:All cases were confirmed intraoperatively.The majority had obstructive jaundice(92.3%).15 cases of hepatauxe were observed intraoperatively.Biliary fistula occurred postoperatively in 2 cases which were cured by conservative treatment.2 patients died,one from advancing obstructive jaundice,hepatic and renal failure,the other from bile duct tissue canceration.Follow up for 3 years the treatment was effective. Conclusion:MS should be considered when obstructive jaudice occurred in patients with a long history of symptomatic gallbladder stones.The majority of MS can be diagnosed preoperatively.The therapeutic approach should be chosen according to the four distinct pathologic type defined in the operation. During cholecytectomy,retrograde or/and partial resection may be the safer alternative.Dissection in the triangle of Calot should be minimized to avoid injury to the common bile duct.T tubes should be placed distal to the fistula.