Department of General Surgery, First Hospital of Lanzhou University, the First Clinical Medical School of Lanzhou University, anzhou, Gansu 730000, China.
Chin Med J (Engl). 2013;126(18):3515-8.
Mirizzi syndrome is often difficult to diagnose before surgery, and is often accompanied by extensive adhesions in the cystohepatic (Calot's) triangle and the difficulty of separating tissue can lead to bile duct injury and other intraoperative and postoperative complications. The aim of this study is to investigate minimally invasive means of treating different types of Mirizzi syndrome.
Fifty-four patients diagnosed with Mirizzi syndrome were enrolled between July 2004 and May 2012. The diagnosis was further refined according to the Csendes classification. Twenty-seven patients were treated with a combination of endoscopic retrograde cholangiopancreatography (ERCP), laparoscopy, and choledochoscopy (tripartite approach group); type I in 16 cases, type II five cases, and type III in six cases. Twenty-seven patients were treated with laparotomy (routine approach group); type I in 19 cases, type II in six cases, and type III in two cases. The operation time, blood loss during operation, initiation of intake time of food, postoperative complications, and hospital stays were compared between two groups.
All patients were successfully cured in surgical operation. The operation time was (49.7 ± 27.5) minutes, blood loss during operation was (21.1 ± 15.9) ml, initiation of intake time of food was (6.3 ± 2.7) hours, postoperative complications were with two cases (7%, 2/27), and hospital stay was (6.7 ± 1.8) days in the tripartite approach group. In the routine approach group, the operation time was (85.1 ± 20.3) minutes, blood loss during operation was (150.3 ± 20.5) ml, initiation of intake time of food was (36.6 ± 10.3) hours, postoperative complications were with three cases (11%, 3/27), and hospital stay was (10.9 ± 3.4) days. Except for postoperative complications, there were significant differences in the operation time, blood loss during operation, initiation of intake time of food, and hospital stays between two groups (P < 0.05).
ERCP combined with laparoscopy and choledochoscopy is a safe and effective means of treating Mirizzi syndrome. The approach is minimally invasive and patients recover quickly requiring only brief hospitalization.
Mirizzi 综合征在术前常常难以诊断，且常伴有胆囊肝（Calot）三角广泛粘连，组织分离困难可导致胆管损伤和其他术中及术后并发症。本研究旨在探讨微创手段治疗不同类型 Mirizzi 综合征。
2004 年 7 月至 2012 年 5 月间，54 例 Mirizzi 综合征患者入组。根据 Csendes 分类进一步细化诊断。27 例患者接受内镜逆行胰胆管造影（ERCP）、腹腔镜和胆总管镜（三联治疗组）联合治疗；16 例 I 型，5 例 II 型，6 例 III 型。27 例行剖腹手术（常规治疗组）；19 例 I 型，6 例 II 型，2 例 III 型。比较两组患者的手术时间、术中出血量、进食开始时间、术后并发症和住院时间。
所有患者均成功治愈。三联治疗组手术时间（49.7 ± 27.5）min，术中出血量（21.1 ± 15.9）ml，进食开始时间（6.3 ± 2.7）h，术后并发症 2 例（7%，2/27），住院时间（6.7 ± 1.8）d。常规治疗组手术时间（85.1 ± 20.3）min，术中出血量（150.3 ± 20.5）ml，进食开始时间（36.6 ± 10.3）h，术后并发症 3 例（11%，3/27），住院时间（10.9 ± 3.4）d。除术后并发症外，两组手术时间、术中出血量、进食开始时间和住院时间差异均有统计学意义（P < 0.05）。
ERCP 联合腹腔镜和胆总管镜是治疗 Mirizzi 综合征的安全有效方法。该方法微创，患者恢复快，仅需短暂住院。
