腹腔镜治疗Mirizzi综合征的系统评价

Systematic review of laparoscopic treatment for Mirizzi syndrome

  • 摘要: 目的 分析腹腔镜治疗Mirizzi综合征(Mirizzi syndrome,MS)的可行性,并确定这一治疗方案相关手术风险和并发症。 方法 系统地检索PubMed、EMBASE和Web of Science英文数据库和万方数据库、清华同方电子数据库(CNKI)、维普中文期刊数据库中2000年1月-2015年6月的相关文献。筛选出包括有至少4例MS腹腔镜治疗患者,有术前诊断率、中转开腹率、并发症发生率及二次手术发生率数据的研究文献进行系统性分析。 结果 从206篇文章中筛选出26篇相关文献。中转开腹率、术后并发症发生率及二次手术率分别为26%、6.8%和1.1%。内镜逆行胰胆管造影术是MS术前诊断检查中最可靠的检查手段,其诊出率高达82%。中转开腹最常见的原因是胆囊三角周围炎性粘连引起的解剖结构不清,占54%。最常见的术后并发症为胆瘘和胆道残余结石。Ⅰ型MS患者中转开腹的发生率(23.4%)低于Ⅱ型MS患者(45.8%)(P< 0.05),Ⅰ型MS患者术后并发症的发生率(3.8%)均低于Ⅱ型MS患者(12%)(P< 0.05)。 结论 腹腔镜治疗Ⅰ型MS可推荐为标准治疗方案,而Ⅱ型MS不推荐腹腔镜治疗。

     

    Abstract: Objective To investigate the feasibility of laparoscopic treatment for Mirizzi syndrome and determine associated risks and complications of this technique. Methods PubMed, EMBASE, Web of Science, Wanfang, CNKI and cqvip databases were searched from January 2000 to June 2015 for related literatures.Four patients with Mirizzi syndrome treated by laparoscopy were enrolled in this study, their preoperative diagnosis rates, conversion laparotomy rate, complication rate and reoperation data were screened and analyzed systematically. Results Of the 206 studies, 26 eligible studies were identified.The conversion laparotomy, complication, and reoperation rates were 26%, 6.8% and 1.1%, respectively.There were no significant differences in the incidence of reoperation(P> 0.05).However, compared with patients in group with low preoperative diagnosis rates, the conversion laparotomy and complication rate of group with high MS diagnosis rate were significantly lower(P<0.05).Compared to patients with type Ⅱ Mirizzi syndrome, patients with type Ⅰ Mirizzi syndrome had a significantly lower risk for conversion and procedurerelated complications(P<0.05). Conclusion The laparoscopic treatment for type Ⅰ Mirizzi syndrome can be recommended as a standard procedure, however, it is not fit for patients with type Ⅱ Mirizzi syndrome.There has a correlation between the increase of preoperative diagnosis rates and the decrease of conversion laparotomy and complication rate.

     

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