以反复剧烈上腹疼痛为表现的肝吸虫病误诊剖析

Misdiagnosis Analysis of Recurrent Severe Upper Abdominal Pain Presented as Clonorchiasis

目的探讨肝吸虫病的临床特征,并提出减少误诊的措施。方法对近期收治曾在外院多次误诊的肝吸虫病1例的临床资料进行回顾性分析。结果本例以反复剧烈腹痛5年,近7 d再次发作并加重入我院。患者曾在多家三甲医院就诊,诊断为胰腺炎、胃炎、胆囊炎、精神疾病等多种疾病并予相应治疗无明显效果,症状仍反复发作。后通过查肝吸虫抗体阳性、吡喹酮试验性治疗及腹腔镜探查确诊为肝吸虫病、慢性胆囊炎,予腹腔镜胆囊切除术,术后检查标本发现在胆囊颈管处有一肝吸虫死亡虫体,后腹痛症状消失,随访半年未见复发。结论肝吸虫病临床表现多样,提高对肝吸虫病流行病学认识及全面细致分析病情是减少误诊的关键。

Objective To explore the clinical features and treatment of clonorchiasis in order to reduce the rates of missed diagnosis and misdiagnosis. Methods A retrospective analysis of clinical data of 1 case of clonorchiasis misdiagnosed as unexplained abdominal pain was made,and the literature was reviewed. Results The patient was admitted for recurrent severe abdominal pain five years and recurrence and aggravation 7 days ago. The patient had been diagnosed as having pancreatitis,or gastritis,or cholecystitis,or mental illness in other hospitals,and appropriate treatment showed no significant effect with abdominal recurrence. The patient was confirmed as having clonorchiasis and chronic cholecystitis by checking the clonorchiasis sinensis antibody positive,praziquantel drug treatment and laparoscopy. Abdominal pain disappeared after laparoscopic cholecystectomy. The patient was followed up for six months with no recurrence. Conclusion The clinical characteristics of the clonorchiasis syndrome are diverse. Enhancing clonorchiasis epidemiology knowledge and comprehensive and detailed analysis of the disease are essential in reducing clonorchiasis misdiagnosis.