目的 探讨对Mirizzi综合征实施临床合理有效的手术方法。方法 自1990年1月至2003年12月期间，我院采用经肝放置胆道支撑引流管治疗Ⅱ、Ⅲ型Mirizzi综合征21例,胆道支撑引流管放置6个月以上，并行胆道造影检查。结果 所有患者恢复良好,胆道造影检查见胆道通畅后拔除支撑引流管，随访2～10年,无并发症发生。结论 经肝放置胆道支撑引流管治疗Ⅱ、Ⅲ型Mirizzi综合征,是保持胆道生理功能完整的有效方法。
目的 探讨Mirizzi综合征的病理特点及合理的诊断治疗方法。 方法 回顾性分析26例经手术确诊的Mirizzi综合征的临床资料。 结果 26例均采用手术治疗，其中行胆囊大部分切除术7例，胆囊切除或胆囊大部分切除加胆总管探查、T管引流术6例，胆囊切除加瘘口修补术11例，胆肠吻合术2例。 结论 Mirizzi综合征术前诊断困难，术中易致胆管损伤，应根据不同的病理分类采取不同的手术方式。
目的探讨Mirizzi综合征的诊断和治疗选择。方法对1982～2000年经手术证实的36例Mirizzi综合征进行回顾性分析。结果术前确诊仅8例(22.2%)，其中5例经ERCP确诊。36例分别选择性地施行了胆囊切除术、胆囊大部切除术、胆管瘘口修补术以及胆肠RouxenY吻合术。32例术后一期愈合，4例出现并发症，其中2例并发胆管狭窄而再次手术。结论B超结合ERCP检查可以提高Mirizzi综合征的术前确诊率， 手术治疗是其主要治疗方法，手术方式取决于局部病理损伤程度和解剖变异。
ObjectiveTo evaluate the value of magnetic resonance cholangiopancreatography (MRCP) on prevention of the complications in laparoscopic cholecystectomy (LC). MethodsThe clinical data of 1 079 patients underwent LC from January 2006 to June 2010 in this hospital were retrospectively analyzed. According to the use of MRCP or not in the different period, the patients were divided into nonMRCP group (n=523) and MRCP group (n=556). The occurrence of bile duct injuries (BDI) and retained common duct stone (RCDS) were compared between two groups. ResultsConversion to open surgery was performed in 35 cases in nonMRCP group and in 41 cases in MRCP group. The intraoperative and postoperative BDI were found in five patients and RCDS were found in 27 patients in nonMRCP group, and those were not found in patients in MRCP group. The differences of BDI and RCDS of patients were significant between two groups (P=0.026 and P=0.000). In nonMRCP group, 23 of 55 patients were found common bile duct stones by intraoperative cholangiography. Common bile duct stones were found by intraoperative cholangiography other than preoperative MRCP in three patients in MRCP group, while another three patients did not find common bile duct stones by intraoperative cholangiography although preoperative MRCP suggested. By MRCP, double gallbladders were found in one patient, Mirizzi syndrome in eight patients, variant cystic duct in 34 patients, accessory hepatic duct in 28 patients, and complicating common bile duct stones in 27 patients in MRCP group, the diagnostic accuracy of those were 100%, 87.5%, 94.1%, 89.3% and 88.9%, respectively. ConclusionPreoperative MRCP is helpful to prevent BDI and RCDS for the patients with LC.
Objective To analyze the preoperative diagnosis and the operative methods for different types of Mirizzi syndrome (MS). Methods Eighty-six cases of MS confirmed by operation were enrolled from March 1990 to December 2008. Their laboratory examination results and X-ray appearances of endoscopic retrograde cholangiopancreatography (ERCP) were analyzed as well as B-ultrasonography (B-us), CT scan and magnetic resonance cholangiopancreatography (MRCP). According to the Csendes typing, different operative methods were adopted. Results The final diagnosis rate by ERCP for MS attained approximately 85.71% (48/56) in contrast with 17.44% (15/86) by B-us, with 9.52% (4/42) by CT scan and with 71.88%（23/32） by MRCP. Twenty cases were Csendes type Ⅰ, 43 cases were type Ⅱ, 17 cases were type Ⅲ, and 6 cases were type Ⅳ. According to the Csendes typing, the cases of type Ⅰ were treated by for the cholecystectomy or partial resection for reserving the neck of gallbladder, type Ⅱ by fistula reparation and laying up the T type drainage-tube under the fistula, and type Ⅲ and type Ⅳ by the hepaticocholangiojejunostomy and hepaticoduodenostomy. Conclusion The preoperative diagnosis for MS is very difficult, B-us may be acted as an accessory diagnostic method. ERCP and MRCP can improve the rate of preoperative diagnosis for MS strikingly. The best reasonable method of the operative therapy is selected according to the different pathologic type of MS.
目的总结Mirizzi综合征的临床特点和诊治经验，探讨提高Mirizzi综合征患者术前确诊率的方法。方法回顾性分析21例Mirizzi综合征患者临床资料。结果术前确诊7例，术中确诊14例。按Csendes分型，Ⅰ型14例，行胆囊切除术8例，胆囊大部分切除加残余胆囊颈部黏膜烧灼2例，胆囊切除加胆总管探查、T管引流术4例； Ⅱ型5例，均行胆囊切除加胆管成形、T管引流术； Ⅲ型2例，1例行胆囊切除加胆管成形、T管引流术，另1例行胆总管空肠Roux-en-Y吻合术。随访6个月~5年，18例临床效果良好。结论胆囊管的解剖变异、胆囊颈或管部结石嵌顿、Calot三角的炎症、粘连等均可单独或合并导致Mirizzi综合征，术前确诊率的提高依赖于对临床资料的综合分析； 治疗应依据病理特点选择个体化手术方案。