华支睾吸虫病致梗阻性黄疸诊治分析

Diagnosis and treatment of obstructive jaundice caused by clonorchiasis.

目的 探讨华支睾吸虫病所致梗阻性黄疸的临床病理特点及治疗方法 ,提高诊治水平。方法 对近年来收治的华支睾吸虫病所致梗阻性黄疸 8例病人进行回顾性总结和临床分析并文献复习。结果 8例病人均有明确食生鱼史。引起梗阻性黄疸的原因 :1例合并有肝门部胆管癌 ,1例合并胆管结石 ,5例为炎性胆管狭窄。全部病人均有嗜酸性粒细胞增多症。CT和B超检查见胆管扩张。粪便中均找到华支睾吸虫卵。 5例病人手术治疗 ,术中在胆管内发现华支睾吸虫成虫及虫卵。结论 华支睾吸虫病所致梗阻性黄疸的病因是炎性胆管狭窄、胆石症、胆管癌和成虫及虫卵阻塞胆管。食生鱼史、嗜酸性粒细胞增多症、粪便中找到华支睾吸虫卵、CT及B超特征性改变均有助于诊断。吡喹酮治疗有效。伴有胆管癌。

Objective To assess clinicopathological features and therapy of obstructive jaundice caused by clonorchiasis, and raise early diagnostic and curative rate.Methods Data from eight patients with obstructive jaundice caused by clonorchiasis were analyzed retrospectively against background of literature.Results All cases had history of eating raw freshwater fish.One patient was associated with biliary obstruction owing to hilar cholangiocarcinoma,,one owing to bile duct stone and five owing to biliary inflammatory stenosis.All cases had eosinophilia in peripheral blood. CT and B-US show dilated branches of biliary tree.Eggs were found in faeces.Five patients underwent operation of relief of biliary obstruction. And adult flukes and eggs were found in biliary duct.Conclusion Biliary inflammatory stenosis, a mass of flukes and eggs, cholangiocarcinoma and bile duct stone may lead to obstructive jaundice in the patients with clonorchiasis. History of eating raw freshwater fish, eosinophilia, finding eggs in stool and CT and B-US manifestations help to make a diagnosis. Praziquantel is highly active against clonorchiasis.When there is obstructive jaundice with acute cholangitis severe type, bile duct stone and cholangiocarcinoma, surgical operations for the patients are needed.