Laparoscopic Biliary Surgery Service, Department of General Surgery, University Hospital Monklands, Airdrie, ML6 0JS, Lanarkshire, Scotland, UK.
Department of Plastic Surgery, Aberdeen Royal Infirmary, Aberdeen, Scotland.
Surg Endosc. 2021 Jul;35(7):3286-3295. doi: 10.1007/s00464-020-07765-4. Epub 2020 Jul 6.
To evaluate the laparoscopic management of Mirizzi syndrome, seldom diagnosed preoperatively causing difficulty when performing cholecystectomy and increasing complication risks.
Analysis of a prospective single-surgeon database of 5700 laparoscopic cholecystectomies found 58 Mirizzi syndrome cases. They were managed with an intention to treat during the index admission according to protocol of single-session management of bile duct stones.
38/58 patients were females (65.5%). The median age was 55 years. 53 cases were emergency admissions. 34 cases (58.6%) only had ultrasound scanning. Operative difficulty was Grade IV in 34 cases (58.6%) and Grade V in 20 (34.5%) (Nassar Scale). There were 33 Mirizzi Type IA, 7 Type IB, 16 Type II and one each of Type III and Type IV. Bile duct exploration was performed in 94.8% through choledochotomy/ transfistula in 58.6% or transcystic in 36.2%. Four cases required conversion to open. Postoperative morbidity occurred in 29%. Two 30-day mortalities occurred from pneumonia in two elderly patients who were late referrals.
Although the utilization of the laparoscopic approach in managing bile duct stones is not currently widely practiced it was safer in this series than in reported series of open surgery in Mirizzi Syndrome. The optimal approach to Mirizzi Type II is via cholecystocholedochal fistula to explore the bile duct then drain with T-tube through the fistula. It is unnecessary to perform bilioenteric bypass in majority of cases, reducing the morbidity and mortality.
评估 Mirizzi 综合征的腹腔镜处理，术前很少诊断导致胆囊切除术困难，并增加并发症风险。
对 5700 例腹腔镜胆囊切除术的前瞻性单外科医生数据库进行分析，发现 58 例 Mirizzi 综合征病例。根据单次管理胆管结石的方案，在指数入院时根据治疗意向对其进行处理。
58 例患者中 38 例为女性（65.5%）。中位年龄为 55 岁。53 例为急诊入院。34 例（58.6%）仅行超声检查。手术难度为 34 例（58.6%）的 IV 级和 20 例（34.5%）的 V 级（Nassar 分级）。有 33 例 Mirizzi 型 IA，7 例 IB，16 例 II 型，1 例 III 型和 1 例 IV 型。94.8%的患者通过胆总管切开术/经皮肝穿刺胆道引流术（58.6%）或经胆囊管进行胆管探查，36.2%的患者通过经胆囊管进行胆管探查。有 4 例需要转为开放手术。29%的患者发生术后并发症。2 例 30 天内死亡，均为两位高龄患者，因延迟转诊导致肺炎。
尽管目前在管理胆管结石中应用腹腔镜方法尚未广泛普及，但在本系列中，与 Mirizzi 综合征的开放手术报道系列相比，其安全性更高。Mirizzi 型 II 型的最佳处理方法是通过胆囊-胆总管瘘管探查胆管，然后通过瘘管放置 T 管引流。大多数情况下无需进行胆肠旁路术，从而降低发病率和死亡率。
