Yuan Haicheng, Yuan Tian, Sun Xiangyu, Zheng Mingwei
*Department of Minimally Invasive Surgery, Tianjin Nankai Hospital, Tianjin †Department of Ultrasonography, Dalian Traditional Chinese Medical Hospital, Liaoning Province, China.
Surg Laparosc Endosc Percutan Tech. 2016 Jun;26(3):248-52. doi: 10.1097/SLE.0000000000000260.
Mirizzi syndrome (MS) is a rare complication of the gallstone disease. Despite the fact that successful laparoscopic treatments have been reported for MS type I, open surgery remains the gold standard approach for MS type II because of the technical difficulties involved.
The aim of this study is to determine the best technique for patients with MS type II by comparing the duration of surgery, loss of blood, rates of complication, duration of hospitalization, and outcomes of long-term follow-up.
From January 2009 to September 2014, combined endoscopic retrograde cholangiopancreatography with laparoscopic surgery for MS type II was implemented. Patients' demographics and treatment outcomes were collected prospectively and during the follow-up.
Forty-nine patients with MS type II were managed with this strategy. Laparoscopic subtotal cholecystectomy was successfully performed in all the patients without conversion or morbidity. When compared with a historical cohort of 57 patients who underwent a surgery for MS, this group of patients had significantly shorter duration of hospitalization (7.21±1.61 vs. 15.31±3.82 d, P<0.01). It also showed less blood loss (162.81±40.83 vs. 207.55±37.01 mL, P=0.425) and less postoperative complications (10.20% vs. 14.04%, P=0.594), although the duration of surgery (165.73±54.33 vs. 156.04±48.61 min, P=0.334) was longer, but these were not statistically significant. However, no significant difference in the rate of recurrence (4.55% vs. 9.52%, P=0.522) of choledocholithiasis was found.
The MS type II can be effectively managed with a laparoscopic surgery combined with preoperative endoscopic retrograde cholangiopancreatography, which is feasible and minimally invasive.
Mirizzi综合征（MS）是胆石症的一种罕见并发症。尽管已有关于I型MS成功进行腹腔镜治疗的报道，但由于技术难度，开放手术仍是II型MS的金标准治疗方法。
本研究旨在通过比较手术时间、失血量、并发症发生率、住院时间和长期随访结果，确定II型MS患者的最佳治疗技术。
2009年1月至2014年9月，对II型MS患者实施内镜逆行胰胆管造影术联合腹腔镜手术。前瞻性收集患者的人口统计学资料和治疗结果，并进行随访。
49例II型MS患者采用该策略进行治疗。所有患者均成功实施腹腔镜胆囊次全切除术，无中转手术或并发症发生。与57例接受MS手术的历史队列患者相比，该组患者的住院时间显著缩短（7.21±1.61天 vs. 15.31±3.82天，P<0.01）。虽然手术时间较长（165.73±54.33分钟 vs. 156.04±48.61分钟，P=0.334），但失血量较少（162.81±40.83毫升 vs. 207.55±37.01毫升，P=0.425），术后并发症较少（10.20% vs. 14.04%，P=0.594），不过这些差异无统计学意义。然而，胆总管结石复发率无显著差异（4.55% vs. 9.52%，P=0.522）。
II型MS可通过腹腔镜手术联合术前内镜逆行胰胆管造影术有效治疗，该方法可行且微创。
