Abstract:Objective:To investigate the diagnosis and surgical treatment of Mirizzi syndrome.
Methods :The clinical data of 35 cases of Mirizzi syndrome treated by surgery were analyzed retrospectively.
Results:The 35 patients included 13 males and 22 females, with mean age of 62.3 years. Forteen cases (40.0 %) were diagnosed as Mirizzi syndrome preoperatively, and 16 cases (60.0 %) were recognized during operation. According to Csendes classification, 9 cases were type Ⅰ, 18 cases type Ⅱ，7 cases type III and 1 case type Ⅳ. Laparoscopic operation was performed in 13 patients, among them, 4 cases（30 %）converted to open laparotomy. The laparoscopic operations included cholecystectomy in 7 cases, and partial cholecystectomy plus intraoperative cholangiography in 2 cases. Tweenty-six patients underwent open laparotomy, including cholecystectomy in 9 cases, partial cholecystectomy plus T-tube drainage in 17 cases, and Roux-en-Y hepaticojejunostomy in 2 cases. Postoperative complications included biliary leakage in 3 cases, infection of incisional wound in 1 case and pneumonia in 1 case, all the complications recovered by non-surgical treatment. Thirty-three cases were followed-up for 1-5 years, the results were satisfactory.
Conclusions:The preoperative diagnosis and intraoperative identification of Mirizzi syndrome, especially during difficult laparoscopic cholecystectomy, should be emphasized, and timely conversion to open surgery could decrease the risk of bile duct injury. Partial cholecystectomy plus intraoperative cholangiography can be helpful to identify pathological change and to reduce the risk of iatrogenic biliary duct injury of Mirizzi syndrom. In the event of serious destruction of biliary duct, Roux-en-Y hepaticojejunostomy is feasible.