35例肝吸虫病诊治分析

Analysis of 35 Patients of Liver Fluke Disease

目的通过对35例人院前误诊或漏诊、入院后确诊肝吸虫病病例临床诊治过程进行分析，加深对该病临床特征的认识，从而减少误诊或漏诊，提高治疗水平。方法对2012年1月-2014年12月于哈尔滨医科大学附属第一医院普外科确诊为肝吸虫病患者的临床表现、并发症、病原学检查、实验室检查、影像学检查、治疗经过结合文献进行回顾性分析。结果35例患者入院诊断中均未包含肝吸虫病，漏诊及误诊率高达100％。1例患者确诊后转院治疗。16例患者因肝胆胰脾彩色多普勒超声（以下简称彩超）、磁共振胰胆管水成像（MRCP）等影像学报告考虑合并胆管系统疾病：7例行胆囊切除＋胆总管切开＋T管引流术，其中1例因行ERCP＋ENBD后出现黄疸，再次行ERCP拖拽出虫体，黄疸消退后行胆囊切除、胆总管切开、T管引流术；9例行经内镜逆行胰胆管造影术（ERCP）＋经内镜十二指肠乳头括约肌切开术（EST）或经内镜鼻胆管引流术（ENBD），其中2例行择期胆囊切除术。术后均予以吡喹酮驱虫治疗，待引流液中无虫体或虫卵查出，造影示胆管通畅后拔除引流管，继续观察3天。18例症状较轻者确诊后单纯予以吡喹酮治疗。34例同时选择性予以保肝、抗感染的综合治疗，效果良好均痊愈出院。结论肝吸虫病缺乏特征性临床表现，一次粪便虫卵检出率低且漏检率高，结合流行病学史、嗜酸性粒细胞、肝吸虫抗体、肝胆胰脾彩超、MRCP等影像学结果综合分析可减少对该病的误诊和漏诊。肝吸虫病合并胆管疾病、胆囊结石行胆囊切除后胆总管探查留置T管引流或ERCP中行十二指肠乳头括约切开术及鼻胆管引流术是有效治疗手段。

Objective By analyzing the diagnosis and therapy of 35 elonorchiasis patients who were misdiagnosed in outpatient department,we try to deepen the understanding of the clinical characteristics of the disease,thereby to reduce misdiagnosis rate and improve the treatment. Methods We analyzed retrospectively the data of patients who were diagnosed with clonorchiasis during January 2012 to December 2014 in the general surgery department of the first affiliated hospital of Harbin medical university, including clinical manifestations, complications, pathogenic examinations, laboratory examinations, imaging examinations and therapy. Results None of the 35 cases were diagnosed with clonorehiasis in outpatient department, misdiagnosis rate is up to 100%. One patient was transferred to another hospital after diagnosed with clonorehiasis. Sixteen cases were combined with biliary tract disease, according to reports of B - ultrasound, MRCP and other imaging examinations. Six cases were performed cholecystectomy, choledochendysis and T- tube drainage; Nine cases were performed ERCP ＋ EST or ENBD, including two cases undergoing selective cholecystectomy, while one case was dragged out parasites at a second time ERCP, who suffered with jaundice after ERCP ＋ ENBD. The patient was performed cholecystectomy, choledochendysis and T - tube drainage after jaundice subsided; All the patients were treated with praziquantel. The biliary drainage tubes couldn＇t be removed until no parasites or eggs were detected and the biliary radiography is good. The patients should stay still three days after the tube removal. Eighteen cases with mild symptoms were simply treated with praziquantel. All of the 34 cases left hospital with good recovery after comprehensive treatment including selectively liver protecting and anti - infective measures. Conclusion Clonorchiasis is lack of specific clinical manifestations. The positive rate of faecal examination is low. Through epidemic history, eosinophils, liver fluke antibodies, B - ultrasound, MRCP and other Imaging results, the diagnostic rate will be enhanced. Cholecystectomy, choledochendysis and T- tube drainage, or ERCP ＋ EST or ENBD are effective treatment methods in clonorchiasis combined with biliary duct disease and cholecystolithiasis.