ABSTRACT
ObjectiveTo investigate the diagnosis, treatment, and outcome of Mirizzi syndrome in patients undergoing laparoscopic cholecystectomy (LC). MethodsA retrospective analysis was performed on the clinical data of 32 patients who underwent LC in the 451 Hospital of PLA from December 2006 to December 2014 and experienced Mirizzi syndrome during the perioperative period. Intraoperative diagnosis, selection of surgical procedures, and evaluation of treatment outcome were summarized. ResultsAmong these patients with Mirizzi syndrome, 8 were diagnosed before surgery and 24 were diagnosed during LC. According to the Csendes classification, 23 patients had type Ⅰ, 7 had type Ⅱ, 1 had type Ⅲ, and 1 had type Ⅳ Mirizzi syndrome. A total of 30 patients completed LC, and they all had type I or Ⅱ Mirizzi syndrome. One patient with type Ⅱ disease underwent LC and common bile duct exploration. Two patients with type Ⅲ or Ⅳ disease were converted to open surgery; the type Ⅲ patient underwent bile duct end-to-end anastomosis, and the type Ⅳ patient underwent choledochoenterostomy. ConclusionMirizzi syndrome is difficult to diagnose, and ultrasonography is the preferred method of examination. A combination of magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography can improve preoperative diagnostic rate. Most cases of type Ⅰ and Ⅱ Mirizzi syndrome can be treated by LC. Open surgery should be considered for type Ⅲ and Ⅳ cases to avoid biliary tract injury.
ABSTRACT
ObjectiveTo investigate the features and methods of clinical diagnosis and treatment of elderly patients with acute calculous cholecystitis. MethodsA retrospective analysis was performed for the clinical data of elderly patients who were diagnosed with acute calculous cholecystitis in 451 Hospital of PLA from June 2012 to June 2015. After admission, all patients received fasting treatment, electrocardiographic monitoring, anti-infective therapy, and maintenance of body fluid balance and stable blood pressure and glucose. According to patients condition choose laparoscopic cholecystectomy open cholecystectomy, open cholecystectomy and common bile duct exploration. ResultsA total of 129 patients were enrolled; among these patients, 119 had acute calculous cholecystitis, 2 had gallstones with adenomatous hyperplasia of the gallbladder mucosa, 6 had pyogenic cholecystitis, and 2 had gallbladder gangrene. Among the patients enrolled, 52 were complicated by at least one internal disease. Among them, 67 underwent emergency surgery since there were no significant improvements in symptoms, and 62 showed relief of symptoms and underwent surgical treatment at other times. Of all patients, 108 underwent laparoscopic cholecystectomy, 9 underwent laparoscopy and were converted to open cholecystectomy, and 9 underwent open cholecystectomy and common bile duct exploration. All the surgeries were successful and all the patients were cured and discharged. There were no deaths. ConclusionElderly patients with acute calculous cholecystitis are in a critical condition and often complicated by various internal diseases. Laparoscopic cholecystectomy is the most commonly used therapeutic method. Clinicians should be fully prepared before surgery, take the perioperative management seriously, and accurately judge the surgical indications and timing.