PDF下载 ( 841 KB)
Clinical diagnosis and treatment of Mirizzi syndrome with gastrointestinal fistula: An analysis of 5 cases
-
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。
-
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.
-
[1]Wu ZD, Wu ZH.Surgery[M].Beijing:People's Medical Publish-ing House, 2003:569.吴在德, 吴肇汉.外科学[M].第6版.北京:人民卫生出版社, 2003:569. [2]Clemtt AR.The roentgen feature of the Mirizzi syndrome[J].Am JRoentgenol, 1965, 94 (11) :480-482. [3]Josephs, Carvajals, oddwin C, et al.Sonographic diagnosis of mirizzisyndrome[J].Climutrasouud, 1985, 13:199-202. [4]Shi JS, Wang BH.Basic and clinical study of biliary surgery[M].Beijing:People's Medical Publishing House, 2003:493-496. (inChinese) 石景森, 王炳煌.胆道外科基础与临床[M].北京:人民卫生出版社出版, 2003:493-496. [5]Yun EJ, Choi CS, Yoon DY, et al.Combination of magnetic reso-nance cholangiopancreatography and computed tomography for pre-operative diagnosis of the Mirizzi syndrome[J].Comput Assist To-mogr, 2009, 33 (4) :636-640. [6]Yu HL, Qiao X, Qiao SX.Surgilal consideration of diagnosis andtheraputic laparoslopy for Mirizzi syndrome[J].J Clin Hepatol, 2012, 28 (2) :114-117. (in Chinese) 俞海龙, 乔昕, 乔士兴.腹腔镜下Mirrizzi综合征的治疗体会[J].临床肝胆病杂, 2012, 28 (2) :114-117. [7]Csendes A, Dais JC, Malucnta F, et al.A new classification ac-cordingtothe evaluative stages in patients, with Mirizzi Syndrome andcholeeystobiliaryfistula and word congress on HPB Surgery[J].AmNorth J Surg, 1988, (Suppl 1) :114. [8]Beltran MA, Csendes A, Cruces KS.The relationship of Mirizzisyndrome and cholecystoenteric fistula:validation of a modifiedclassification[J].World J Surg, 2008, 32 (10) :2237-2243. [9]Chen F, Song HL, Jin XD, et al.Analysis of laparoscopic surgery intreatment of Mirizzi syndrome[J].J Hepatobiliary Surg, 2008, 16 (4) :290-291. (in Chinese) 陈峰, 宋洪亮, 金肖丹, 等.Mirizzi综合征的腹腔镜手术治疗分析[J].肝胆外科杂志, 2008, 16 (4) :290-291. [10]Wang J, Liu YX, Feng YQ, et al.Long-term results after surgicalrepair of benign biliary stricture by pedicle flap of autogenous tissues[J].Chin J Hepatobiliary Surg, 1998, 4 (6) :162-164. (inChinese) 王敬, 刘永雄, 冯玉泉, 等.利用自体带蒂组织瓣修复手术后胆管狭窄[J].中华肝胆外科杂志, 1998, 4 (6) :162-164. [11]Pavlos L, Nikolaos P, Athanasios M, et al.Mirizzi syndrome typeVa:A rare coexistence of double cholecysto-biliary and cholecysto-enteric fistulae[J].World J Radiol, 2010, 2 (10) :410-413. [12]Gomez D, Rahman SH, Toogood GJ, et al.Mirizzi’s syndrome-results from a large western experience[J].HPB (Oxford) , 2006, 8 (6) :474-479. -
本文二维码
计量
- 文章访问数: 243
- HTML全文浏览量: 12
- PDF下载量: 38
- 被引次数: 0
下载:
