Rohatgi A, Singh K K
Hospital Worthing Hospital, Lyndhurst Road, Worthing, West Sussex, BN11 2HR, UK.
Surg Endosc. 2006 Sep;20(9):1477-81. doi: 10.1007/s00464-005-0623-6. Epub 2006 Jul 24.
The authors present their experience with laparoscopic subtotal cholecystectomy for the management of Mirizzi's syndrome and their review of the literature.
Over a period of 24 months, five cases of Mirizzi's syndrome were encountered, representing 1.5% of all the laparoscopic cholecystectomies performed in the authors' unit. The sex ratio was 4 females to 1 male, and the mean age of the patients was 66 years. All underwent a subtotal cholecystectomy.
All procedures were completed laparoscopically. Morbidities involved one case of biliary peritonitis and a one case of biliary leak requiring endoscopic stenting.
Mirizzi's syndrome cannot always be anticipated on the basis of preoperative staging, and often is encountered during the procedure. The "anatomic scenario" of this condition should be suspected for patients presenting with conditions such as empyema or mucocoele when there is a likelihood of stone impaction in the infundibulum of the gallbladder. Subtotal cholecystectomy with secure intraperitoneal biliary drainage appears to be a safe option for these patients.
作者介绍了他们运用腹腔镜胆囊次全切除术治疗Mirizzi综合征的经验并对相关文献进行了综述。
在24个月的时间里，共遇到5例Mirizzi综合征患者，占作者所在科室所有腹腔镜胆囊切除术的1.5%。男女比例为4:1，患者平均年龄为66岁。所有患者均接受了胆囊次全切除术。
所有手术均通过腹腔镜完成。并发症包括1例胆汁性腹膜炎和1例需要内镜支架置入的胆漏。
Mirizzi综合征不能总是根据术前分期预测，且常在手术过程中遇到。当患有脓胸或黏液囊肿等疾病且胆囊漏斗部有可能出现结石嵌顿时，应怀疑患有这种疾病的“解剖情况”。对于这些患者，行胆囊次全切除术并进行可靠的腹腔内胆汁引流似乎是一种安全的选择。
