腹腔镜下Mirizzi综合征的治疗体会

俞海龙; 乔昕; 乔士兴

腹腔镜下Mirizzi综合征的治疗体会

吉林大学第二医院普通外科疾病诊疗中心

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中图分类号: R657.4
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出版历程
- 出版日期: 2012-02-20

Surgical consideration of diagnosis and therapeutic laparoscopy for Mirizzi syndrome

摘要

摘要: 目的探讨Mirizzi综合征（MS）的诊断及腹腔镜下治疗MS的价值与术中处理方法。方法回顾性分析我院2004年12月至2010年3月腹腔镜胆囊切除术（LC）中26例MS患者的临床资料。结果 26例MS,术前诊断7例,其余均为术中诊断。Ⅰ型18例,其中16例成功施行了LC手术,2例中转开腹;Ⅱ型5例,2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。其余3例中转开腹;Ⅲ型3例均中转开腹,1例行瘘口修补,2例行胆囊切除+Roux-en-Y胆道重建。结论 B超是首选的检查方法,内镜下逆行胰胆管造影术（ERCP）、磁共振胰胆管成像（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MS病例,对于Ⅲ型及Ⅳ型患者,腹腔镜下处理较为困难,应尽量开腹处理。
- Mirizzi综合征 /
- 胆囊切除术,腹腔镜
Abstract: Objective To evaluate the diagnosis of Mirizzi syndrome (MS) and the surgical consideration of laparoscopy for MS.Methods we retrospectively analyzed the data on 26 cases of MS undergoing LC between from December 2004 to March 2010 in our unit.Results The diagnosis before operation was made in 7 cases of the 26 cases, and the others were diagnosed intraoperatively.Among 18 cases of type Ⅰ, 16 were treated with LC and 2 were converted to open abdominal operation;Among 5 cases of type Ⅱ, 2 were treated with laparoscopic management by subtotal cholecystectomy and choledochoplasty with remnant of the gallbladder, and a bile duct exploration and T tube insertion, 3 were converted to open abdominal operation;All of 3 cases of type Ⅲ were converted to open abdominal operation.2 were treated with Roux-en-Y hepaticojejunostomy.Conclusion Ultrasonography is thought to be the first screening choice, and associates with ERCP and MRCP, the preoperative diagnosis rate can be much more improved.Most of MS cases of type Ⅰ and type Ⅱ can be treated safely by the way of the association for laparoscope and choledochoscope.The cases of type Ⅲ and type Ⅳ should be treated with an open approach, whereas LC is hard to complete.
- Mirizzi syndrome /
- cholecystectomy

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参考文献(8)

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