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目的探讨重症华支睾吸虫病的临床特点,寻找有效的诊治方法。方法本组38例,均行粪便华支睾吸虫虫卵、肝功能、肝胆B超、CT及/或MRI、或血清华支睾吸虫抗原抗体等检查,34例合并阻塞性黄疽者31例行内镜下逆行胰胆管造影(ERCP),4例有肝实质占位性改变者行肝穿剌活检病理检查,其中3例予手术探查,部分病例予吡喹酮试验治疗。结果34例合并阻塞性黄疽或伴胆囊炎、胆总管结石、化脓性胆管炎、胆管癌,其中26例予ERCP+乳头括约肌切开术(EST)+鼻胆管引流术(ENBD),合并胆总管结石者取石治疗,均予吡喹酮驱虫治疗;3例仅予吡喹酮治疗,以上29例治疗后3～4周肝功能正常或明显改善,胆管直径恢复正常或明显缩小后症状改善;5例合并胆管癌者3例放置金属支架治疗+吡喹酮治疗,2例手术治疗。4例合并肝脏占位性病变,3例手术探查明确诊断,1例予吡喹酮试验性治疗3d,2周后肝脏病灶消失,随访6年无复发。结论对华支睾吸虫性胆道梗阻诊断未明确者或合并胆管结石、胆管严重阻塞黄疸显著、胆总管明显扩张首选ERCP诊治+驱虫治疗。对诊断明确而无肝外胆管扩张的单纯性华支睾吸虫性胆道梗阻可先行驱虫治疗,效果不理想再行介入治疗,可减少患者痛苦和节约费用;对疑为华支睾吸虫性肝脏改变者提倡B超肝穿刺活组织检查,吡喹酮试验性治疗有效也可确诊。
Objective To investigate the clinical features of severe clonorchiasis and find out the effective diagnosis and treatment methods. Methods Thirty-eight patients in this group were examined for eggs, liver function, liver and gallbladder ultrasonography, CT and / or MRI or Clonorchis sinensis antigen and antibody in Clonorchis sinensis, and 34 patients with obstructive jaundice Endoscopic retrograde cholangiopancreatography (ERCP), 4 cases of hepatic parenchymal lesions were liver biopsy biopsy, of which 3 cases were surgical exploration, in some cases to praziquantel treatment. Results Of the 34 patients with obstructive jaundice or cholecystitis, common bile duct stones, suppurative cholangitis and cholangiocarcinoma, 26 cases were treated with ERCP + EST and nasal biliary drainage (ENBD) All stones were treated with praziquantel and deworming. All the patients were treated with praziquantel only. The function of the liver in the above 29 cases was normal or obviously improved after 3 ~ 4 weeks. The diameter of the biliary duct returned to normal or conspicuously decreased. 5 cases of cholangiocarcinoma were placed in metal stent treatment with praziquantel 3 cases, 2 cases of surgical treatment. 4 cases of liver space-occupying lesions, 3 cases of surgical exploration of a clear diagnosis, 1 case of praziquantel experimental treatment 3d, 2 weeks after the disappearance of liver lesions, no recurrence 6 years follow-up. Conclusions Clinic diagnosis of Clonorchis sinensis biliary obstruction is not clear or complicated with bile duct stones, bile duct obstruction was significant jaundice, the obvious expansion of the common bile duct ERCP diagnosis and treatment + deworming treatment. On the diagnosis of clear and no extrahepatic bile duct dilatation of pure clonorchiasis biliary obstruction may be the first deworming treatment, the effect is not satisfactory then interventional treatment can reduce patient pain and save costs; for suspected clonorchis sinensis liver Change to promote B-liver biopsy, praziquantel experimental treatment can be diagnosed effectively.