肝吸虫性肝胆疾病22例分析  

Clinical analysis of 22 patients with hepatobiliary disease caused by liver fluke

作　　者：张会[1] 朱磊[2] 王璐[3] 陈倩[1] 潘煜[1] 

机构地区：[1]吉林大学白求恩第一医院肝胆胰内科,长春130021 [2]哈尔滨医科大学附属第二医院普外二科,哈尔滨150086 [3]吉林大学中日联谊医院神经内科,长春130033

出　　处：《临床肝胆病杂志》2013年第7期538-540,共3页Journal of Clinical Hepatology

摘　　要：目的通过对肝吸虫致肝胆疾病的临床分析,增加对该病的认识,减少误诊。方法回顾性分析本院1992年至2012年以肝胆疾病入院后确诊为肝吸虫病患者22例。其中男19例,女3例,平均年龄45.41岁,其中入院诊断为胆囊炎或胆结石8例、肝吸虫病7例,其他7例。结果实验室检查ALT升高者14例(63.63%)、AST升高者16例(72.72%)、TBil升高者11例(50.00%)、GGT升高者17例(77.27%)、嗜酸性粒细胞(E)升高者14例(63.63%)、大便集卵检查确诊10例(45.45%),胆汁涂片确诊7例(31.82%)、肝吸虫抗体检测确诊2例、既往肝吸虫病史者3例;经驱虫及综合治疗后预后良好。结论肝吸虫病具有地方性,临床少见且临床表现无特异性,易与其他肝胆疾病混淆,误诊率高。对于病因不明腹痛、黄疸、肝损害患者应注意询问患者及家人有无特殊饮食史,应注意行相关检查明确诊断,避免延误治疗。Objective To clinically analyze the hepatobiliary disease caused by the liver fluke and to increase the knowledge of this disease and reduce misdiagnosis. Methods A retrospective analysis was performed on the clinical data of 22 patients who had a confirmed diagnosis of clonorchiasis after being admitted to our hospital due to hepatobiliary disease over the past 20 years. Results Of the 22 patients, who had a mean age of 45.41 years, 19 were males, and 3 were females. When admitted to the hospital, 8 cases were diagnosed with cholecystitis or gallstones, 7 cases with clonorchiasis, and 7 cases with other diseases. Alanine aminotransferase elevation was found in 14 cases （63.63%）, aspartate aminotransferase elevation in 16 cases （72.72%）, total bilirubin elevation in 11 cases （50. 00% ）, gamma -glu- tamyl transpeptidase elevation in 17 cases （77.27%）, and increased eosinophils in 14 cases （63.63%）. Ten cases （45.45%） were diag- nosed by fecal examination, 7 cases （31. 82% ） by bile smears, 2 cases （9.09%） by liver fluke antibody detection, and 3 cases （ 13.64% ） according to the history of clonorchiasis. Deworming and comprehensive treatment produced a good outcome in these patients. Conclusion Clonorchiasis is endemic and clinically rare, without specific clinical features, and it is easily confused with other hepatobiliary diseases, resulting in a high rate of misdiagnosis. Therefore, for the patients with abdominal pain, jaundice, and liver damage of unknown causes, we should inquire whether they or their family have a special dietary history and need to perform relevant examinations to confirm the diagnosis, so as to provide timely treatment.

关 键 词：片形吸虫 肝 误诊 

分 类 号：R532.2[医药卫生—内科学]