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

作　　者：朱风尚[1] 张勤[1] 张俊杰[1] 常义忠[1] 张景涛[2] 鲁星燧[2] 杨长青[1] ZHU Fengshang, ZHANG Qin, ZHANG Junjie, et al.(Department of Gastroenterology, Tong]i Hospital of Tongfi University, Shanghai 200065, Chin)

机构地区：[1]同济大学附属同济医院消化内科,上海200065 [2]同济大学附属同济医院肝胆外科,上海200065

出　　处：《临床肝胆病杂志》2018年第3期583-587,共5页Journal of Clinical Hepatology

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χ~2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%,χ~2=6.903,P=0.009)。诊断方法上,B组多层螺旋CT(MSCT)(26.9%vs 8.6%,χ~2=18.576,P<0.001)、超声内镜(EUS)(15.7%vs 5.8%,χ~2=8.352,P=0.004)、磁共振胰胆管造影(MRCP)(75.0%vs 33.1%,χ~2=67.303,P<0.001)和经内镜逆行胰胆管造影(ERCP)(63.4%vs 36.7%,χ~2=26.377,P<0.001)使用比例明显增加,但误诊率并没有下降(22.8%vs28.1%,χ~2=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(χ~2=34.758,P<0.001)。内镜手术组与药物保守治疗组相比(χ~2=40.211,P<0.001),外科手术组与药物保守治疗组相比(χ~2=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(χ~2=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。Objective To 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. Methods A 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.Results Compared 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%,χ~2= 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%,χ~2= 18. 576,P 0. 001）,endoscopic ultrasonography（ EUS）（ 15. 7% vs 5. 8%,χ~2= 8. 352,P = 0. 004）,magnetic resonance cholangiopancreatography（ MRCP）（ 75. 0% vs 33. 1%,χ~2= 67. 303,P 0. 001）,or endoscopic retrograde cholangiopancreatography（ ERCP）（ 63. 4% vs 36. 7%,χ~2=26. 377,P 0. 001）,while the two groups had a similar false positive rate（ 22. 8% vs 28. 1%,χ~2= 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 c

关 键 词：LEMMEL综合征 胰胆管造影术 内窥镜逆行 诊断 治疗 

分 类 号：R657.45[医药卫生—外科学]