Mirizzi综合征16例诊治体会

目的 探讨Mirizzi综合征的临床特点,总结诊断和治疗经验,提高对其恶变的认识.方法 分析回顾临床所遇16例患者的诊治过程.结果 术前明确诊断率不高,手术方法比较多,Ⅰ型行胆囊切除或胆囊大部切除术,Ⅱ型行胆囊切除、胆管修补加T管引流术,Ⅲ型、Ⅳ型行胆囊切除、肝总管空肠吻合术.胆囊癌变者二期行胆囊癌根治术.结论mirizzi综合征术前明确诊断率不高,胆囊癌变的可能性较大,治疗应根据不同类型选择适当的手术方式,术中或术后应及时送病理检查,排除癌变.

Experience in diagnosis and treatment of 16 cases of Mirizzi syndrome

Objective To investigate the clinical characteristics of patients with Mirizzi syndrome and summarize our experience in diagnosis,treatment and outcomes.Methods The clinical data for all 16 cases of Mirizzi syndrome that were treated at our hospital between 1997 and 2011 were retrospectively analyzed.Results The rate of definitive diagnosis prior to surgical intervention was poor.The surgical procedures used on these patients varied according to Mirizzi syndrome type.Patients with type I Mirizzi syndrome underwent cholecystectomy or subtotal cholecystectomy.Patients with type Ⅱ underwent cholecystectomy followed by closure of the bile duct plus T-tube drainage of common bile duct.Patients with type Ⅲ and type Ⅳ underwent cholecystectomy and hepaticojejunostomy.Treatment of Mirizzi-associated gallbladder cancer was carried out by radical surgical excision of the biliary cystadenocarcinoma.Conclusion The poor rate of preoperative definitive diagnosis of Mirizzi syndrome may contribute to progression to cancer.The operative strategy should be designed according to the various types of Mirizzi syndrome.In order to inhibit progression to cancer or initiate cancer therapy as early as possible,pathological examination should be carried out during the initial operation or immediately afterwards.