Sindromul Mirizzi tendințe actuale în diagnosticul și tratamentul chirurgical

Abstract

Scopul lucrării. Evaluarea particularităților de diagnostic și tratament chirurgical al pacienților cu Sindrom Mirizzi. Materiale și metode: Din lotul total de studiu ce a inclus 75 pacienți, în 27 cazuri (36%) diagnosticul a fost stabilit preoperator, utilizând următoarele investigații: USG-75 (100%), ERCP-69 (92%), MRCP-18 (24%), CT cu contrast-12 (16%). Complexitatea majoră a constituit 48 (64%) cazuri, unde constatarea SM a fost intraoperatorie. Rezultate. Tratamentul chirurgical a fost adaptat tipului de SM. Tip I-17 (22,6%) pacienți, a fost prezentă confluenţa vezico-coledociană, un început de formare a fistulei, a fost efectuată colecistectomia. Tip II-28 (37,3%), defectul parietal CBP a fost sub 1/3 din diametrul lui, s-a efectuat plastia defectului CBP pe drenajul Kehr. Tip III-18 (24%), defectul CBP a constituit 2/3 din diametru, dintre care în 12 cazuri (16%) s-a efectuat plastia CBP cu lambou vascularizat din vezicula biliară și drenarea CBP tip Robson, în alte 6 cazuri (8%) s-a efectuat hepaticojejuno-anastomoză pe ansa „Y” a la Roux. Tip IV-10 (13,3%), defectul parietal a fost de peste 67% din diametrul CBP, s-a efectuat exclusiv hepaticojejuno-anastomoză pe ansa „Y” a la Roux. Tip V-2 (2,6%) s-a efectuat drenarea CBP tip Kehr și suturarea fistulei enterice. Concluzii. Arsenalul laparascopic a permis soluționarea integrală minim invaziv a 22 cazuri ce a inclus pacienți cu SM tip I și II. SM tip III, IV necesită obligatoriu intervenții chirurgicale cu elemente de reconstrucții biliodigestive.

Aim of study. Evaluation of the particularities of diagnosis and surgical treatment of patients with Mirizzi Syndrome. Materials and methods. From the total study group that included 75 patients, in 27 cases (36%) the diagnosis was established preoperatively, using the following investigations: USG-75(100%), ERCP-69 (92%), MRCP- 18 (24%), CT with contrast-12 (16%). The major complication constituted 48(64%) cases, where the finding of MS was intraoperative. Results. The surgical treatment was adapted to the type of MS. Type I-17 (22.6%) patients, the bladder-choledochal confluence was present, a beginning of fistula formation, cholecystectomy was performed. Type II-28 (37.3%), the CBP parietal defect was below 1/3 of its diameter, the CBP defect plasty was performed on the Kehr drainage. Type III-18 (24%), the CBP defect constituted 2/3 of the diameter, of which in 12 cases (16%), CBP plasty with a vascularized flap from the gallbladder and Robson-type CBP drainage was performed in another 6 cases (8%) hepaticojejunostomy was performed on the Roux "Y" loop. Type IV-10(13.3%), the parietal defect was over 67% of the CBP diameter, exclusively hepaticojejunostomy was performed on the Roux "Y" loop. Type V-2(2.6%) was performed Kehr-type CBP drainage and enteric fistula suturing. Conclusions. The laparoscopic arsenal allowed the complete minimally invasive solution of 22 cases that included patients with type I and II MS. MS type III, IV necessarily requires surgical interventions with elements of biliodigestive reconstructions.