摘要
目的 探讨 Mirizzi's综合症临床病理特征及外科诊治原则 .方法 收集我院 1984 - 0 8/2 0 0 2 - 0 2间手术治疗且资料完整的本综合症病例共 38例 ,其临床病理特征与外科术式的关系 .结果 138(男 15 ,女 2 3)例中均有 Murphy's征阳性和不同程度 Charcot's三联征表现 .诊断性检查示肝内外胆管扩张或 (和 )胆总管壁弧形压迹 . 2临床病理类型按文献方法 :38例中 a型 15例 , b型 15例和 c型 8例 .按本文分型方法则 型 15例 , 型 2 3例 . 3术中纤维胆道镜检查有胆管粘膜炎症表现 . 4行胆囊切除术 +胆总管探查引流术 18例 ,胆囊切除术 +胆总管探查引流术 +胆总管壁缺损修复术2 0例 .结论 1去除病因、解除梗阻、修复缺损和引流胆道是本综合征外科治疗的基本原则 . 2胆囊 (部分 )切除 +胆总管探查引流术是其基本术式 ,若有胆内瘘或肝外胆管壁缺损 ,应同时修复缺损 . 3应重视本综合征术前诊断及围手术期处理 。
AIM To investigate the clinical pathologic characters and the principles of diagnosis and treatment in Mirizzi's syndrome. METHODS To analysis retrospectively the data of clinic and operation in 38 cases of Mirizzi'ssyndrome treated in our hospital from August, 1984 to March, 2002. RESULTS ①Charcot's triad and Murphy's sign were observed in 38 cases of Mirizzi's syndrome. Dilation of intro extrohepatic bile duct and/or a curve impression of extrohepatic bile duct were demonstrated clearly by diagnostic examination (ultrasound, CT and/or ERCP). ②Clinic pathologically, typeⅠa, Ⅱb and Ⅱc were 15, 15 and 8 cases, respectively. Congestion and dropsy and hemorrhagic spot were visible with fibroendoscopy operatively. ③Cholecystectomy and exploratory choledochostomy were performed in all of 38 cases while common bile duct defect were repaired with pedicled gallbladder flap in 23 of 38 cases. CONCLUSION ①Removing pathogeny, relieving obstruction, repairing defect and driaining biliary duct are the basic principles of surgical treatment in cases with Mirizzi's syndrome. ②Cholecystectomy (or partial excision) with exploration of common bile duct is the basic surgical procedure in all case, and a repair procedure of large common bile duct defect should be made in some cases with biliobiliary fistula in the same time. ③A special attention should be given to the pre operative diagnosis and to the exploration and drainage of the biliary duct in patients with Mirizzi's syndrome.
出处
《第四军医大学学报》
北大核心
2002年第21期1996-1996,共1页
Journal of the Fourth Military Medical University
