肝吸虫性胆管炎误诊为胆管癌病例分析

An analysis of hepatic cholangitis cases of clonochis sinensis infected with misdiagnosed as cholangiocarcinoma

目的报道3例肝吸虫性胆管炎的诊治经过,总结临床经验教训。方法对3例肝吸虫性胆管炎误诊为胆管癌临床资料进行回顾性总结分析。结果 3例肝吸虫性胆管炎病人均为男性,年龄50～65岁,均有食鱼生史,1例因"上腹部疼痛4天"入院,1例因"反复上腹痛1月余"入院,1例因"反复上腹疼痛半年"入院,3例术前均误诊为胆管癌,行手术探查,手术方式为胆囊切除、胆总管切开探查、胆道镜检查、T管引流术,术中胆管内均可见大量华支睾吸虫虫体,其中1例形成化脓性胆管炎,术中胆道镜探查肝内外胆管未见明显肿物以及狭窄,术后无明显并发症,均痊愈出院。结论对于高度怀疑胆管癌的肝吸虫性胆管炎患者先驱虫治疗后观察胆管系统情况再决定是否手术探查是比较合适的治疗方案。

Objective To introduce the diagnosis and treatment of 3 cases of hepatic cholangitis with clonorchis sinensis infected and summarize the clinical experience. Methods The clinical characteristic of clonorchiasis sinensis misdiagnosed as cholangiocarcinoma were retrospectively analyzed. Results Sexuality of 3 hepatic clonorchis infected patients all were male, age ranged from 50 y to 65 y, and with a story of eating rawfish. The case 1 suffered from upper abdominal pain for 4 days, case 2 had upper abdominal pain for 1 month, and case 3 with upper abdominal pain for 6 months. All the patients ,were misdiagnosed as cholangiocarcinoma before operation. All the three patients underwent surgical treatments included cholecystectomy, choledochotomy with exploration and cholangoscopy, and T tube drainage. In three patients, a large number of clonorchiasis worms were observed during operation, and one of them developed suppurative cholangitis. The patients was cured with no obvious complications. Conclusion For patients with hepatic cholangitis who highly suspected cholangiocarcinoma, it is a more appropriate decision for next surgical plan after dewonning treatment, repeated imaging studies or multiple endoscopy combinations.