临床研究(Clinical Research)

Mirizzi 综合征诊断与治疗10 年回顾

Published at: 2015年第24卷第2期

曾娟 1 , 吕超 1 , 吴硕东 1
1 中国医科大学附属盛京医院 胆道血管外科,辽宁 沈阳 110004
通讯作者 硕东 吴 Email: wushuodong@aliyun.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2015.02.018
基金:

摘要

目的:总结10 年间Mirizzi 综合征(MS)的诊治经验,为临床提供借鉴。方法:回顾2004—2013 年间收治的27 例MS 患者临床资料,包括3 例保守治疗,24 例手术治疗,主要将24 例手术患者的术前资料、手术方式、术后恢复及随访情况进行分析与总结。结果:24 例手术患者中,术前确诊率为54.2%(13/24),术前MRCP 对MS 的确诊率高于彩超和腹部CT,23 例(95.8%)术后病理诊断为慢性胆囊炎。10 例腹腔镜手术患者中,除1 例因腹腔粘连严重转为开腹,术后腹痛症状反复外,余未出现术中及术后并发症,远期随访结果良好;14 例开腹手术患者中,术后2 例出现少量胆汁漏,随访发现1 例长期腹痛,1 例T 管拔除延迟,1 例出现切口疝及肠梗阻。结论:MS 的术前确诊率低,完善术前检查有助于提高术前确诊率,以便合理选择术式,减少术中并发症。腹腔镜手术治疗MS 具有一定的优势。


Diagnosis and treatment of Mirizzi syndrome: a 10-year experience

Abstract

Objective: To review the experience of 10 years in diagnosis and treatment of Mirizzi syndrome (MS), so as to provide information for clinical practice. Methods: Twenty-seven MS patients admitted during 2004 to 2013 were reviewed. Of the patents, 3 cases received conservative treatment and 24 cases underwent surgical treatment, and the preoperative data, surgical procedures, postoperative recovery and follow-up result of the surgical patients were chiefly reviewed and analyzed. Results: In the 24 patients undergoing surgery, the preoperative diagnotic rate was 54.2% (13/24), the preoperative detection rate for MS by MRCP was higher than that by color Doppler ultrasound and abdominal CT scan, and 23 cases were diagnosed as chronic cholecystitis by postoperative pathology. In the 10 patients undergoing laparoscopic surgery, except for one case who was converted to open surgery due to severe intraabdominal adhesions and had repeated abdominal pain after surgery, no intra- or postoperative complications occurred and long-term follow-up results were satisfactory in the remaining cases; in the 14 patients undergoing open surgery, small bile leakage occurred in 2 cases after surgery, and during follow-up, long-standing abdominal pain was noted in one case, one case had recurrence of jaundice and abdominal pain, T-tube removal was delayed in one case, and one case developed incisional hernia and intestinal obstruction. Conclusion: Preoperative diagnostic rate of MS is low, so the improvement of preoperative examination may help increase its preoperative diagnotic rate, thereby allowing a proper selection of operative procedure and reducing operative complications. Laparoscopic approach has certain superiority in treatment of MS.


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引用

引用本文: 娟 曾, 超 吕, 硕东 吴. Mirizzi 综合征诊断与治疗10 年回顾[J]. 中国普通外科杂志, 2015, 24(2): 247-253.
Cite this article as: ZENG Juan, LU Chao, WU Shuodong . Diagnosis and treatment of Mirizzi syndrome: a 10-year experience[J]. Chin J Gen Surg, 2015, 24(2): 247-253.