腹腔镜手术联合T管引流术对Mirizzi综合征患者的临床疗效分析

杨勇; 金雷

doi:10.7619/jcmp.201918008

腹腔镜手术联合T管引流术对Mirizzi综合征患者的临床疗效分析

杨勇,
金雷^,

陕西省西安市第九医院普外二科, 陕西西安, 710054

详细信息

通讯作者:
金雷, E-mail: jlking0127@gmail.com

中图分类号: R657.4
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出版历程
- 收稿日期: 2019-06-11
- 录用日期: 2019-07-24
- 网络出版日期: 2021-02-28
- 发布日期: 2019-09-27

Clinical efficacy of laparoscopic surgery combined with T-tube drainage for patients with Mirizzi syndrome

YANG Yong,
JIN Lei^,

Department of General Surgery, Ninth Hospital of Xi′an, Xi′an, Shaanxi, 710054

摘要

摘要:
目的探讨腹腔镜手术联合T管引流术对Mirizzi综合征患者的临床疗效。
方法纳入Mirizzi综合征患者60例，按照不同手术方法分为对照组28例和腹腔镜组32例。对照组采用开腹胆囊切除术联合T管引流术，腹腔镜组采用腹腔镜手术联合T管引流术。分析2组患者的手术结果、随访结果以及并发症发生率，并比较2组患者围术期的临床指标(包括手术时间、术中出血量、引流时间、住院时间、术后排气时间)和术后满意度结果。
结果 2组患者均顺利完成手术，腹腔镜组中有5例患者因胆囊三角处发生较为严重的粘连而中转开腹手术。2组患者术后并发症发生率比较，差异无统计意义(P>0.05)。术后随访显示, 2组患者手术后均使用T管引流3~6个月，造影显示胆管通畅，后经闭管观察显示无异常后拔管。2组患者随访过程中均未出现胆瘘、胆结石复发以及胆总管狭窄，预后良好。腹腔镜组的术中出血量、住院时间和术后排气时间均显著优于对照组(P < 0.05)。2组的手术时间、引流时间比较，差异无统计学意义(P>0.05)。腹腔镜组的手术满意率显著高于对照组(P < 0.05)。
结论 Ⅱ型和Ⅲ型Mirizzi综合征患者的胆道结构较为复杂，故术后发生并发症的风险明显增大，术前应对Mirizzi综合征患者进行正确分型，明确手术方法和手术风险，以降低中转开腹、胆道损伤以及相关并发症的发生率，改善患者预后。
- 腹腔镜手术 /
- T管引流术 /
- Mirizzi综合征 /
- 疗效
Abstract:
Objective To evaluate the clinical efficacy of laparoscopic surgery combined with T-tube drainage in patients with Mirizzi syndrome.
Methods A total of 60 patients with Mirizzi syndrome who were treated in our hospital were divided into control group (n=28)and laparoscopic group (n=32) according to different surgical methods. The control group was treated with open cholecystectomy combined with T-tube drainage, and the laparoscopic group was treated with laparoscopic surgery combined with T-tube drainage. The surgical results, follow-up results, and incidence of complication of the two groups were analyzed. Perioperative clinical indicators including operative time, intraoperative blood loss, drainage time, hospital stay, postoperative exhaust time and postoperative satisfaction were compared between the two groups.
Results The operations of both groups were successfully completed. Out of the 32 patients in the laparoscopic group, 5 patients were converted to open surgery due to more serious adhesions in the gallbladder triangle. There was no statistically significant difference in the incidence of postoperative complications between the two groups (P>0.05). The results of followed up showed that the patients used T-tube drainage for 3 to 6 months after operation. Angiography showing that bile duct was unobstructed, the catheter was extubated after observing the tube was normal. There were no occurrence of biliary tract, gallstones, and common bile duct stricture during the follow-up in the two groups, and they had better prognosis. The intraoperative blood loss, hospital stay and postoperative exhaust time in the laparoscopic group were significantly better than those in the control group (P < 0.05). There were no significant differences in the operation time and drainage time between the laparoscopic group and the control group (P>0.05). The satisfaction of the laparoscopic group was significantly higher than that of the control group (P < 0.05).
Conclusion The biliary structures of patients with type Ⅱ and Ⅲ Mirizzi syndrome are complicated, which cause a higher risk of postoperative complications. Preoperative classifications of patients with Mirizzi syndrome should be done to determine the surgical procedure and surgical risk to reduce the incidence of conversion to open surgery, biliary tract injury and related complications, and to improve the prognosis of patients.
- laparoscopic surgery /
- T-tube drainage /
- Mirizzi syndrome /
- curative effect

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表 1 2组患者术后并发症发生情况比较[n(%)]

并发症	对照组(n=28)	腹腔镜组(n=32)
胆瘘	2(7.14)	3(9.38)
胆管炎	0	1(3.13)
伤口感染	1(3.57)	1(3.13)
T管脱出	1(3.57)	0
合计	4(14.29)	5(15.63)

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表 2 2组患者围术期临床指标比较(x±s)

组别	n	手术时间/min	术中出血量/mL	住院时间/d	引流时间/d	术后排气时间/h
对照组	28	83.49±16.25	97.48±22.36	9.57±2.65	4.03±1.24	23.36±5.84
腹腔镜组	32	79.62±15.33	51.36±19.64^*	7.69±2.14^*	3.59±1.10	12.54±4.49^*
与对照组相比, *P < 0.05。

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表 3 2组患者的手术满意度评价[n(%)]

手术满意情况	对照组(n=28)	腹腔镜组(n=32)
满意	17(60.71)	24(75.00)
基本满意	5(17.88)	7(21.87)
不满意	6(21.43)	1(3.13)
手术满意	22(78.57)	31(96.87)^*
与对照组相比, *P < 0.05。

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