The Application Of Laparoscopic Technique In Mirizzi Syndrome

Objective:Discussing the feasibility of diagnostic method and laparoscopic treatment of Mirizzi syndrome.Methods:1.Retrospective method is applied to collect 9080 cases of laparoscopic cholecystectomy of the First Affiliated Hospital of Dalian Medical University,the Second Hospital of Dalian Medical University,Dalian Municipal Central Hospital Affiliated of Dalian Medical University and Affiliated Zhongshan Hospital of Dalian University from January 2010 to October 2017,including defined 82 cases of Mirizzi syndrome.2.Preoperative inspection method includes ultrasonic,CT(Computed Tomography),MRCP(Magnetic Resonance Cholangiopancreatography)and ERCP(Endoscopic Retrograde Cholangiopancreatography).3.There are 8 operation methods in total: LC(1aparoscopic cholecystectomy),LSC(1aparoscopic subtotal cholecystectomy)+choledochotomy + T-tube stent drainage,LSC+ orifucium fistulae direct neoplasty + T-tube stent drainage,LSC+ gall bladder wall orifucium fistulae neoplasty + T-tube supporting drainage,ENBD(Endoscopic Nasobiliary Drainage)+ stent implantation + stage-II laparoscopic partial-cholecystectomy + stage-III stent extraction,laparoscopic cholecystectomy to open surgery,laparoscopic cholecystectomy to open surgery+ choledochojejunostomy Rouxen-Y,partial cholecystectomy to open laparotomy + gall bladder wall orifucium fistulae neoplasty + T-tube stent drainage.4.SPSS 24 software is used for statistical analysis,and the enumeration data is expressed in rate(%),the comparison among groups is subject to chi-square test and P<0.05 difference shows the statistical significance? Results:1.Preoperative examination: Accuracy rate of diagnosis is 22.85% for ultrasound,17.5% for CT,66.6% for MRCP and 80% for ERCP.2.Operation method: a total of 42 cases of type I divided in accordance with Csendes,32 cases of LC,4 cases of LSC,6 cases of cholecystectomy performed during conversion from laparoscope to laparotomy;20 cases of type II,7 cases of LSC + direct fistulae neoplasty + T-tube supported drainage,4 cases of LSC + fistulae neoplasty in gallbladder wall + T-tube supported drainage,4 cases of ENBD+ stent implantation + phase II LSC+ phase III stent removal,3 cases of partial gallbladder excision performed during conversion to laparotomy + fistulae neoplasty in gallbladder wall + T-tube supported drainage,2 cases of gallbladder excision performed during conversion to laparotomy + Roux-en-Y anastomosis;14 cases of type III,4 cases of LSC + fistulae neoplasty in gallbladder wall + T-tube supported drainage,2 cases of ENBD+ stent implantation +phase II partial gallbladder excision with laparoscope+ phase III stent removal,8 cases of gallbladder excision performed during conversion to laparotomy + Roux-en-Y;a total of 6 cases of type IV,6 cases of gallbladder excision performed during conversion to laparotomy + Roux-en-Y.3.Postoperative complications: 12 cases in this group(14.4%)have postoperative bile leak in total,including 3 cases of I type,3 cases of II type,4 cases of III type and 2 cases of IV type,recovered after conservative treatment for peritoneal unobstructed drainage.There are 10 cases in this group(12%)having incision infection in total,including 3 cases of I type,2 cases of II type,3 cases of III type,and 2 cases of IV type,with condition improved after dressing change for treatment.1 case of abdominal infection(1.2%)is conversion to open laparotomy case of MS III type with conditions improved after conservative treatment such as B ultrasound-guided PTGD,negative pressure suction,anti-infection,and nutrition support etc.;1 case of postoperative abdominal hemorrhage is conversion to open laparotomy case of MS III type(1.2%),bleeding stopped after conservation treatment through injecting hemocoagulase,supplementing coagulation factor and vit K1 etc.Conclusion:Preoperative diagnosis of Mirizzi syndrome is difficult,and ultrasound and CT can be only taken as preliminary examination means.MRCP can be taken as one kind of noninvasive means to improve diagnostic accuracy rate.ERCP cannot only be taken as preoperative auxiliary examination mean,but also can be taken as preoperative auxiliary treatment mean.Data in this research shows that I type and II type of Mirizzi syndrome can be subject to laparoscopic technique under the premise of mature laparoscopic technique,and it is not suitable to use laparoscopic technique in III type and IV type of Mirizzi syndrome;but we believe that laparoscopic treatment for III type and IV type of Mirizzi syndrome will become possible with the improvement for laparoscopic suture technique and development for robot technology etc.and laparoscopic double stapling technique.