| Objective:Type ? Mirizzi Syndrome is one type of Mirizzi Syndrome(MS),which is a relatively rare type of cholecystolithiasis.In patients with Mirizzi syndrome,due to the presence of gallbladder stones that compress the common bile duct in the neck of the gallbladder,pain,nausea,vomiting,jaundice and other clinical symptoms are caused.At present,academic circles divide them into four types.Retrospective analysis was performed on 9911 cases of patients with cystic stone surgery in chenzhou hospital affiliated to nanhua university in the past 12 years.Among these 9911 cases,87 cases of patients with Mirizzi syndrome were found,and 40 cases of patients with type ? Mirizzi syndrome were found.In this regard,the clinical diagnosis and treatment of 40 cases of type ? Mirizzi syndrome were discussed.To provide better treatment experience for patients with type ? Mirizzi syndrome.Methods:1.Retrospective study method is the guiding method of this experiment.A total of 9,911 cases of chenzhou hospital affiliated to nanhua university who were hospitalized for gallbladder stone disease between January 2006 and December 2018 and treated with cholecystectomy as the basic treatment were collected.Among the 9911 patients,a total of 87(about 0.8% of the total)were finally diagnosed with Mirizzi syndrome.Among them,there were 29 cases of type I,40 cases of type ?,13 cases of type ?I and 5 cases of type IV(the proportions of type I,?,?I and IV in 87 cases of MS were 33%,46%,15% and 6% respectively).The preoperative clinical manifestations,auxiliary diagnostic methods,surgical methods and treatment results of type ? Mirizzi syndrome were analyzed and discussed.2.Preoperative examination methods of the selected samples involved:abdominal 3D color doppler ultrasonography,abdominal computed tomography,cholangiopancreatography,duodenoscopic retrograde cholangiopancreatography.3.In case the operation method of sample used include:(1)+laparoscopic cholecystectomy fistula repair directly absorbable sutures+ T tube drainage + support abdominal cavity drainage,(2)the laparoscopic resection of gallbladder most + "triangle" residual gallbladder fistula repair + T tube drainage + abdominal cavity drainage,(3)support laparoscopic cholecystectomy + liver round ligament fistula repair + T tube drainage + abdominal cavity drainage,(4)support open cholecystectomy + cut take bravery manager stone fistula repair + T tube drainage + support abdominal cavity drainage.Patients undergoing laparotomy and laparoscopic surgery were divided into two groups.The operative methods adopted in the open group were open cholecystectomy +common bile duct lithotomy fistula repair + t-tube support drainage +abdominal drainage.The surgical methods adopted in the laparoscopic surgery group were laparoscopic cholecystectomy + direct fistula repair with absorbable suture + t-tube support drainage + abdominal drainage,and the cases were included in group A.The operative methods adopted were laparoscopic majority cholecystectomy + "triangle" fistula repair for residual gallbladder wall + t-tube support drainage + abdominal drainage,and the patients were included in group B1.The operative methods adopted were laparoscopic cholecystectomy + fistula repair of hepatic roundXligament + t-tube support drainage + abdominal drainage,and the patients were included in group B2.4.Statistical analysis: applying SPSS20.0 to statistical analysis of data,measurement data first to normality test,accord with normal distribution,the comparison between the two way using independent sample t-test,the results using x + s said,do not accord with normal distribution using nonparametric test,the results using M(P25,P75)said.Counting data were compared by chi-square test,and P<0.05 was considered statistically significant.Results:From January 2006 to December 2018,40 cases of type ? Mirizzi syndrome were found among 9911 patients who underwent cholecystectomy at chenzhou hospital affiliated to the university of south China due to cystic lithiasis.There were 17 male patients and 23 female patients.The mean age was 49.60 12.22 years.Preoperative examination: the detection rate of abdominal 3D color doppler ultrasound was 14.7%.The detection rate of abdominal computed tomography(CT)was 5.3%.The detection rate of MRCP was 40.9%.The detection rate of ERCP was 57.1%.40 cases of type ? Mirizzi syndrome were treated by open surgery(6cases)and laparoscopic surgery(34 cases),respectively.Laparoscopic surgery was divided into two methods: group A(20 cases)and group B(14cases),and group B was subdivided into two subgroups,group B1(9 cases)and group B2(5 cases).Patients in the laparotomy group were hospitalized longer than those in the laparoscopic group,and their postoperative recovery was slower than those in the laparoscopic group.The number of patients with incision infection in the open surgery group was more than that in the laparoscopic group.In this experiment,abdominal infection only appeared in the patients in the open surgery group.Puncture catheter drainage under the guidance of abdominal color ultrasound positioning andnegative pressure suction ball device were fully drainage.After the conservative treatment such as anti-infection and nutritional support,the abdominal infection improved.The incidence of postoperative peritoneal hemorrhage was higher in the open group than in the laparoscopic group,but the incidence was generally lower,and the bleeding stopped after conservative treatment.Conclusion:Type ? Mirizzi syndrome is a rare clinical disease with a low preoperative diagnosis rate.Compared with open surgery for type ? Mirizzi syndrome,laparoscopic surgery takes slightly less time and the amount of intraoperative blood loss is slightly less in the former,which requires further discussion of more sample sizes.Compared with the approach of "triangle" residual gallbladder flap to repair the fistula,the former has certain advantages in shortening the operation time and reducing intraoperative bleeding,but the long-term effects need to be further studied and demonstrated. |
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