Diagnosis And Treatment Of 182 Cases Of Lemmel's Syndrome

Objective: To explore the diagnosis and treatment of Lemmel's syndrome,to strengthen the understanding of Lemmel's syndrome,to improve the early diagnosis and treatment of the disease,and to choose the appropriate treatment method.Methods: To retrospectively analyze the clinical features,diagnosis methods,treatment methods and prognosis of 182 Lemmel's syndrome cases were confirmed by hyponotic duodenography,endoscopic retrograde cholangiopancreatography(ERCP)and magnetic resonance cholangiopancreatography(MRCP)who were treated in the First Affiliated Hospital of Dalian Medical University,the Second Affiliated Hospital of Dalian Medical University,Dalian Medical University Affiliated Dalian Municipal Central Hospital,Affiliated Zhongshan Hospital to Dalian University from May 2002 to July 2017.Results: Lemmel's syndrome was diagnosed in 182 cases,90 males and 92 females,aged 32 to 91 years,mean age 67.2 ± 7.5 years.Less than 39 years of age in 6 cases,accounting for 3.3%(6/182),between 40 and 49 in 13 cases,accounting for 7.1%(13/182),between 50 and 59 in 25 cases,accounting for 13.7%(25/182),between 60 and 69 in 49 cases,accounting for 26.9%(49/182),between 70 and 79 in 56 cases,accounting for 30.8%(56/182),more than 80 years old in 33 cases,accounting for18.2%(33/182).The main clinical manifestations were abdominal pain in 182 cases,accounting for 100%(182/182),jaundice in 115 cases,accounted for 63.2%(115/182),nausea in 90 cases,accounting for 49.5%(90/182),fever in 60 cases,accounting for33%(60/182),vomiting in 58 cases,accounting for 31.9%(58/182),shivering in 31 cases,accounting for 17%(31/182),abdominal distension in 21 cases,accounting for11.5%(21/182).Of 182 patients,84 cases were confirmed by endoscopic retrograde cholangiopancreatography(ERCP),accounting for 46.1%(84/182).62 cases were confirmed by hyponotic duodenography,accounting for 34.1%(62/182).36 cases were diagnosed by magnetic resonance cholangiopancreatography(MRCP),accounting for19.8%(36/182).Of 182 patients,133 cases were given medical treatment,accounting for 73.1%(133/182).49 cases were given surgical treatment,accounting for 26.9%(49/182).Patients with medical treatment were well recovered,except for 5 cases of occasional seizures.The five patients,due to their older age,chosed to continue the conservative treatment.Among the surgically treated patients,19 cases underwent Billroth ? subtotal gastrectomy,accounting for 10.4%(19/182),endoscopic sphincterotomy(EST)in 18 cases,accounting for 9.9%(18/182),diverticulectomy in 5cases,accounting for 2.8%(5/182)and Roux-en-Y gastrojejunostomy in 4 cases,accounting for 2.2%(4/182),Roux-en-Y choledochojejunostomy in 2 cases,accounting for 1.1%(2/182),pancreaticoduodenectomy in 1 case,accounting for 0.5%(1/182).All patients treated surgically recovered smoothly,without recurrence and obvious discomfort.Conclusion: Lemmel's syndrome is rare in clinic.This study found that the disease occurred mostly in people over 40 years old,the peak age was 70~79 years old,and the incidence increased with age.There was no typical clinical manifestation in Lemmel's syndrome,so clinical diagnosis is very difficult.Doctors should attach importance to mutual identification of common diseases such as cholelithiasis,gastritis,duodenal ulcer,perforation of duodenum,etc.,so as to avoid missed diagnosis and misdiagnosis,and delay the best time to treat.Abdominal ultrasonography(US),computed tomography(CT)and laboratory examination can assist in the diagnosis of this disease.Hyponotic duodenography,ERCP and MRCP can be used to confirmed Lemmel's syndrome.Medicine,Billroth ? subtotal gastrectomy,EST,Roux-en-Y gastrojejunostomy,Roux-en-Y choledochojejunostomy,and pancreatoduodenectomy are all effective therapies.