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我国Lemmel综合征诊治方法20年变化分析
Changes in the diagnostic and therapeutic methods for Lemmel′s syndrome over the past 20 years in China
文章发布日期:2018年02月07日  来源:  作者:朱风尚, 张 勤,张俊杰,等  点击次数:756次  下载次数:96次

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【摘要】:目的探讨国内20年来Lemmel综合征诊治方法的变化,为今后规范该病诊治提供借鉴。方法回顾性收集1998年1月-2017年6月在同济大学附属同济医院诊治的23例及国内公开报道的384例Lemmel综合征患者,共计407例。按收治时间分为1998-2007年(A组,n=139)和2008-2017年(B组,n=268)。记录患者临床特征、诊断和治疗方法及预后。正态分布的计量资料2组间比较用t检验,不符合正态分布的计量资料2组间比较用Wilcoxon秩和检验,计数资料2组间比较用χ2检验。结果临床表现上B组患者较A组发病年龄升高[(67.8±17.8)岁 vs (62.3±12.3)岁,t=-13.238,P=0.019]、胆管炎发生比例高(45.9% vs 324%, χ2=6.903,P=0.009)。诊断方法上,B组多层螺旋CT(MSCT)(26.9% vs 8.6%, χ2=18.576,P<0.001)、超声内镜(EUS) (15.7% vs 5.8%, χ2=8.352,P=0.004)、磁共振胰胆管造影(MRCP) (75.0% vs 33.1%, χ2=67.303,P<0.001)和经内镜逆行胰胆管造影(ERCP) (63.4 % vs 36.7%,χ2=26.377,P<0.001)使用比例明显增加,但误诊率并没有下降(22.8% vs 281%, χ2=1.385,P=0.239)。治疗上,和A组相比,B组以ERCP手术治疗为主,药物保守治疗、外科手术治疗为辅的治疗模式(χ2=34758,P<0.001)。内镜手术组与药物保守治疗组相比(χ2=40.211,P<0.001),外科手术组与药物保守治疗组相比(χ2=26785,P<0.001),复发率的差异均有统计学意义。外科手术与内镜手术治疗组比,复发率差异无统计学意义(χ2=0.055,P=0815),但内镜手术治疗更具有微创、恢复快和经济优势。结论Lemmel综合征患者发病年龄不断增大,诊断上以MSCT、EUS、MRCP和ERCP及其联合方法为主, 目前ERCP术为其首选的治疗手段。
【Abstract】:ObjectiveTo investigate the changes in the diagnostic and therapeutic methods for Lemmel′s syndrome over the past 20 years in China, and to provide experience for standardized diagnosis and treatment of this disease. MethodsA retrospective analysis was performed for the clinical data of 23 patients with Lemmel′s syndrome who were diagnosed and treated in Tongji Hospital of Tongji University from January 1998 to June 2017 and 384 patients with Lemmel′s syndrome reported in China during the same period of time (407 patients in total). According to the admission time, the patients were divided into groups A (139 patients admitted from 1998 to 2007) and B (268 patients admitted from 2008 to 2017). The patients′ clinical features, diagnostic and therapeutic methods, and prognosis were recorded. The t-test was used for comparison of normally distributed continuous data between groups, and the Wilcoxon rank sum test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. ResultsCompared with group A, group B had significantly higher age of onset (67.8±17.8 vs 62.3±12.3, t=-13.238, P= 0.019) and incidence rate of cholangitis (45.9% vs 32.4%, χ2=6.903, P=0.009). As for diagnostic methods, compared with group A, group B had a significantly higher proportion of patients who used multi-slice spiral CT (MSCT) (26.9% vs 8.6%, χ2=18.576, P<0.001), endoscopic ultrasonography (EUS) (15.7% vs 5.8%, χ2=8.352, P=0.004), magnetic resonance cholangiopancreatography (MRCP) (75.0% vs 33.1%, χ2=67.303, P<0.001), or endoscopic retrograde cholangiopancreatography (ERCP) (63.4% vs 36.7%, χ2=26377, P<0.001), while the two groups had a similar false positive rate (22.8% vs 28.1%, χ2=1.385, P=0.239). As for therapeutic methods, compared with group A, group B had a significantly higher proportion of patients who underwent ERCP combined with conservative pharmacotherapy and surgical operation (χ2=34.758, P<0.001). There was a significant difference in recurrence rate between endoscopic surgery group and conservative pharmacotherapy group (χ2=40.211, P<0.001), as well as between surgical operation group and conservative pharmacotherapy group (χ2=26.785, P<0.001); there was no significant difference in recurrence rate between surgical operation group and endoscopic surgery group (χ2=0.055, P=0.815), but endoscopic surgery had the advantages of minimal invasiveness, fast recovery, and low costs. ConclusionAge of onset of Lemmel′s syndrome is gradually increasing. MSCT, EUS, MRCP, and ERCP applied alone or in combination are major diagnostic methods, and ERCP is the preferred therapeutic method for Lemmel′s syndrome.
【关键字】:Lemmel综合征; 胰胆管造影术, 内窥镜逆行; 诊断; 治疗
【Key words】:Lemmel′s syndrome; cholangiopancreatography, endoscopic retrograde; diagnosis; therapy
【引证本文】:ZHU FS, ZHANG Q, ZHANG JJ, et al. Changes in the diagnostic and therapeutic methods for Lemmel′s syndrome over the past 20 years in China[J]. J Clin Hepatol, 2018, 34(3): 583-587. (in Chinese)
朱风尚, 张勤, 张俊杰, 等. 我国Lemmel综合征诊治方法20年变化分析[J]. 临床肝胆病杂志, 2018, 34(3): 583-587.

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