Laennec入路腹腔镜胆囊切除术治疗Mirrizi综合征Ⅱ型

doi:10.3877/cma.j.issn.1674-6899.2023.03.014

中华腔镜外科杂志(电子版) ›› 2023, Vol. 16 ›› Issue (03) : 190 -192. doi: 10.3877/cma.j.issn.1674-6899.2023.03.014

病例报告

Laennec入路腹腔镜胆囊切除术治疗Mirrizi综合征Ⅱ型

张志恒¹, 张来柱¹, 彭进¹, 余德才¹^,^†(

)

^1. 210008　南京大学医学院附属鼓楼医院普通外科肝胆与肝移植外科

收稿日期:2023-04-16 出版日期:2023-06-30
通信作者: 余德才
基金资助:
国家自然科学基金(82173129；82203330)

Laparoscopic cholecystectomy via Laennec approach through the cystic plate for gallbladder stone with type Ⅱ Mirizzi syndrome

Zhiheng Zhang¹, Laizhu Zhang¹, Jin Peng¹, Decai Yu¹^,^†()

^1. Hepatobiliary Surgery & Liver Transplantation Center, Nanjing Drum Tower Hospital Affiliated to School of Medicine of Nanjing University, Jiangsu, 210008, China

Received:2023-04-16 Published:2023-06-30
Corresponding author: Decai Yu

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目的

总结、描述Laennec入路腹腔镜胆囊切除术治疗Mirrizi综合征Ⅱ型，探索该方案的可行性。

方法

选取Ⅱ型Mirrizi综合征患者1例，完善术前检查，排除绝对手术禁忌，2022年3月实施腹腔镜胆囊切除术，Laennec入路分离胆囊板，便于肝总管成形，放置T管，治疗Mirrizi综合征Ⅱ型患者。

结果

手术时间约100 min，术中出血30 ml，T管引流每日400~700 ml。患者术后第7天出院，无并发症。术后6周复查T管造影未见胆总管结石，肝外胆管无狭窄或扩张，并予拔除。随访12个月，患者无异常。

结论

腹腔镜Laennec膜入路治疗Ⅱ型Mirrizi综合征是安全可行的，尚需更多临床病案验证。

关键词: 腹腔镜胆囊切除术, 胆总管重建, Laennec入路, 胆结石, Ⅱ型Mirrizi综合征

Objective

To investigate the safety and feasibility of Laennec approach for laparoscopic cholecystectomy in the treatment of type II Mirrizi syndrome.

Methods

A patient with type II Mirrizi syndrome underwent laparoscopic cholecystectomy.

Result

The patient was discharged on postoperative day 7 without complications. The tomogram was performed 6 weeks after surgery to assess the anatomy and exclude stones in the CBD prior to its removal.

Conclusions

It is safe and feasible to treat type II Mirrizi syndrome with laparoscopic cholecystectomy via Laennec approach, more evidence is needed in large-scale clinical studies.

Key words: Laparoscopic cholecystectomy, CBD reconstruction, Laennec approach, Gallbladder stones, Type II Mirizzi syndrome

图1 MRCP显示胆囊结石伴Ⅱ型MS注：A.肝脏磁共振T1加权像；B-C.肝脏磁共振T2加权像；D.肝脏MRCP成像。

图2 手术关键步骤注：A-B.暴露胆囊三角及Rouviere氏沟；C-D.通过Laennec膜入路分离胆囊床；E.离断胆囊颈部，显露胆囊体及胆囊底；F.在胆囊胆管漏处纵向切开，移除结石，切开胆囊底和胆囊颈；G.胆道镜探查胆总管有无残余结石；H.瘘管与胆总管重建；I.将胆囊颈、胆囊床及胆总管重建；J-K.检查有无胆漏和出血；L.将引流管放于肝肾隐窝。红色区域显示Laennec膜存在部位。

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Laparoscopic cholecystectomy via Laennec approach through the cystic plate for gallbladder stone with type Ⅱ Mirizzi syndrome