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Clinical diagnosis and treatment of Mirizzi syndrome with gastrointestinal fistula: An analysis of 5 cases
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摘要:
目的探讨Mirizzi综合征合并消化道瘘的临床诊断及治疗方法。方法回顾性分析2006年5月-2011年11月间经手术证实的5例Mirizzi综合征合并消化道瘘患者的临床资料。结果 5例Mirizzi综合征患者术前经B超、磁共振胰胆管造影（MRCP）检查,按Csendes分型法分为Ⅱ型1例、Ⅲ型3例、Ⅳ型1例。术中证实合并消化道瘘,行Roux-肝总管空肠吻合术2例,行肝圆韧带胆管修复术3例,患者住院时间最短14 d,最长28 d,平均23 d。术后胆漏2例,经腹腔冲洗后自行闭合。结论 Mirizzi综合征在胆道损伤的基础上合并消化道损伤时,术前诊断困难,手术操作复杂,术前应对手术复杂程度有充分的估计及准备,并根据探查结果选择手术方式。
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关键词:
- Mirizzi综合征 /
- 消化系统瘘 /
- 消化系统外科手术
Abstract:Objective To investigate the clinical diagnosis and treatment of Mirizzi syndrome with gastrointestinal fistula.Methods A retrospective analysis was performed on the clinical date of 5 cases of Mirizzi syndrome with gastrointestinal fistula that were surgically confirmed from May 2006 to November 2011.Results The 5 cases of Mirizzi syndrome were examined by B-mode ultrasound and magnetic resonance cholangiopancreatography before surgery and were classified as Csendes type Ⅱ (1 case) , type Ⅲ (3 cases) , and type Ⅳ (1 case) .Mirizzi syndrome was surgically confirmed to be associated with gastrointestinal fistula in these patients.Two cases were treated by Roux-Y hepatojejunostomy, and 3 cases underwent bile duct repair with the round ligament of liver.The mean hospital stay was 23 d (range, 14-28 d) .Postoperative bile leakage was found in two cases, but both were cured by peritoneal lavage.Conclusion Mirizzi syndrome with gastrointestinal injuries is characterized by difficult preoperative diagnosis and complex surgical treatment.The assessment of surgical complexity and preoperative preparation should be made, and the surgical procedures should be individualized after surgical exploration.
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