ObjectiveSump syndrome is a rare composition of side-to-side choledochoduodenostomy(CDD),because of debris,stones or sludge accumulate in the sump,the segment of common bile duct between the anastomosis and the ampulla of Vater,that lead to a series of clinical symptoms,such as abdominal pain,fever,vomiting,jaundice,ea ct.The incidence of Sump syndrome is very low.No specific clinical manifestation and laboratory examination find in it,and there is no standardized diagnosis and treatment plan.In this article,it mainly discusses the causes of Sump syndrome,clinical manifestation,diagnosis and treatment,and to compared the clinic effect of the endoscopic treatment and surgical treatment.In order to raise awareness of Sump syndrome and the diagnosis and treatment level.MethodsDuring the period from June 2000 to August 2017,24 patients with Sump syndrome after CDD who are underwent endoscopic treating and surgical therapy were admitted to the hospital patients.Quality control method: The Sump syndrome who diagnosed through medical history,physical examination,and auxiliary examination,such as blood routine,biochemistry,abdominal level film,abdominal B-ultrasound,CT,ERCP and ect.Exclusion criteria: Sump syndrome with non-CDD surgery or accompany with malignant tumor.15 were male and 9 were female,with age distribution ranging from 45 to 75,with an average age(61.00±8.67),The duration of the disease ranged from 5d to 3y(median time 18 days)and from 2 to 15 years after CDD(average of 7 years).Through the analysis of clinical methods and results,and then summarize the choice of clinical methods,DU,CT,ERCP three methods of positive rate of the double reaction variables of the design variance analysis,if the difference has statistical significance,then further two comparison.P < 0.05 for the difference was statistically significant.To compare the time of operation,intraoperative bleeding,gastrointestinal recovery and postoperative hospitalization in 2 groups of patients with endoscopic treatment and surgical treatment,the above data were analyzed,and it was proved that endoscopic treatment of Sump syndrome had obvious advantages.The data were analyzed by SAS9.1.3 software.The mean value of measurement data was indicated by mean±standard deviation or median(quartile spacing).The statistics of the count data to rate(%),comparison between groups using chi square test 2.P < 0.05 for the difference was statistically significant.ResultsIn this group,24 cases were diagnosed with ultrasound and 9 cases were diagnosed.By CT examination of 19 cases,confirmed 7 cases;24 cases were examined and 21 cases were confirmed with endoscopic retrograde cholangiography(ERCP).The positive rates of DU and CT were 31.58 % and 36.48 %,they was diagnosed with no significant difference(P>0.05).The positive rate of ERCP was 89.74 %,higher than that of DU and CT(P<0.05).Among the 24 patients in this group,16 patients were treated underwent endoscopic treating and 8 patients in the control group were treated by surgical therapy.However,compared with surgical therapy,endoscopic surgery requires less time,less intraoperative blood loss,faster gastrointestinal recovery,and shorter postoperative hospital stay.All patients had better results.The overall effect of postoperative follow-up was satisfactory.ConclusionsSump syndrome is rare composition,but increased patient frequency.Young medical workers are unfamiliar with it and it is difficult to diagnose.Preoperative detailed medical history collection and careful body examination are the key to diagnosis of Sump syndrome.Doppler Ultrasonography Examination can be used as the first choice.Endoscopic therapy is recommended for patients with Sump syndrome,which has a positive effect on recovery.EST is used most often,but should be selected according to the specific situation of the patient.Endoscopic treatment has the advantages of minimally invasive,safe,reliable,shorter operation time,quick postoperative recovery,avoiding the risk of reoperation,and difficulty.Most Sump syndromes can be treated effectively with Endoscopy,and Roux-en-Y Cholecystostomy may be considered for failure or recurrent symptoms. |