Cui Yunfeng, Liu Yong, Li Zhonglian, Zhao Erpeng, Zhang Hongtao, Cui Naiqiang
Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China.
ANZ J Surg. 2012 Oct;82(10):708-13. doi: 10.1111/j.1445-2197.2012.06149.x. Epub 2012 Aug 20.
Mirizzi syndrome is an important and rare complication of gallstone disease. This study aims to evaluate the treatment approach by analysing the diagnostic method and the outcome of surgical treatment in our hospital.
We retrospectively analysed the data of 198 patients with Mirizzi syndrome between January 2004 and January 2010. The records were reviewed for demography, clinical presentation, diagnostic method, operative procedure, postoperative complication and follow-up.
The incidence of Mirizzi syndrome was 0.66% of 29 875 patients who underwent cholecystectomy for cholelithiasis. The incidence of types I, II, III and IV was 59.1%, 24.7%, 13.1% and 3.1%, respectively. In this study, ultrasonography and magnetic resonance cholangiopancreatography (MRCP) could have the suspicion of Mirizzi syndrome in 77.8% and 82.3% of cases. Cholecystectomy also has been shown to be effective for type I Mirizzi syndrome. Our common surgical approach in Mirizzi syndrome types II and III was partial cholecystectomy without removal of the portion of gallbladder around the fistula margin. For some cases, choledochoplasty was needed. For Mirizzi syndrome type IV, we performed hepaticojejunostomy for all patients.
Ultrasound, MRCP and endoscopic retrograde cholangiopancreatography in combination with choledochoscope procedure in operation could improve the diagnostic sensitivity of Mirizzi syndrome. Intraoperative choledochoscope is effective to confirm Mirizzi syndrome during operation. Open surgery is the current standard for managing patients with Mirizzi syndrome. Laparoscopic surgery should be confined to Mirizzi syndrome type I and patients should be selected very strictly.
Mirizzi综合征是胆石症一种重要且罕见的并发症。本研究旨在通过分析我院的诊断方法及手术治疗结果来评估其治疗方法。
我们回顾性分析了2004年1月至2010年1月期间198例Mirizzi综合征患者的数据。对人口统计学、临床表现、诊断方法、手术操作、术后并发症及随访情况进行了记录回顾。
在29875例行胆囊切除术治疗胆结石的患者中，Mirizzi综合征的发生率为0.66%。Ⅰ型、Ⅱ型、Ⅲ型和Ⅳ型的发生率分别为59.1%、24.7%、13.1%和3.1%。在本研究中，超声检查和磁共振胰胆管造影（MRCP）对Mirizzi综合征的可疑率分别为77.8%和82.3%。胆囊切除术对Ⅰ型Mirizzi综合征也显示出有效。我们对Ⅱ型和Ⅲ型Mirizzi综合征的常用手术方法是部分胆囊切除术，不切除瘘口边缘周围的胆囊部分。对于一些病例，需要进行胆总管成形术。对于Ⅳ型Mirizzi综合征，我们对所有患者均行了肝空肠吻合术。
超声、MRCP以及术中联合使用内镜逆行胰胆管造影和胆道镜检查可提高Mirizzi综合征的诊断敏感性。术中胆道镜有助于在手术中确诊Mirizzi综合征。开放手术是目前治疗Mirizzi综合征患者的标准方法。腹腔镜手术应仅限于Ⅰ型Mirizzi综合征，且患者选择应非常严格。
