Diagnosis of clonorchiasis during and after biliary tract surgery: a clinical analysis of 15 cases
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摘要: 目的分析胆道外科手术过程中发现肝吸虫病的临床特点,为肝吸虫病的外科治疗提供更全面、有效的诊疗信息。方法回顾性分析吉林大学白求恩第一医院肝胆胰外科2013年1月-2016年1月胆道手术中及术后发现的15例肝吸虫病患者临床资料,总结其临床特点。结果 15例患者全部为男性,其中5例患者明确曾生食淡水鱼虾,8例行腹腔镜胆道探查术,7例行经内镜逆行胰胆管造影(ERCP),均于术中或术后引流液中发现成虫。15例患者规律驱虫治疗后治愈。结论胆道探查术中发现灰黑色或鲜红色瓜子样絮状物,应高度怀疑肝吸虫,并建议术中留置T管引流;腹腔镜胆道探查术T管引流术后或ERCP鼻胆管引流术后发现可疑肝吸虫,需进一步行微生物学检查;已经明确的肝吸虫病,需杜绝生食鱼虾并行规律的驱虫治疗。Abstract: Objective To investigate the clinical features of clonorchiasis diagnosed during biliary surgery,and to provide more comprehensive and effective information for the surgical treatment of clonorchiasis. Methods A retrospective analysis was performed for the clinical data of 15 patients who were diagnosed with clonorchiasis during and after biliary tract surgery in our department from January 2013 to January 2016,and their clinical features were summarized. Results All the 15 patients were male,among whom 5 once ate uncooked freshwater fish and shrimps. Of all patients,8 underwent laparoscopic bile duct exploration and 7 underwent endoscopic retrograde cholangiopancreatography( ERCP). Adult Clonorchis sinensis was found in intraoperative or postoperative drainage. All the patients achieved clearance of Clonorchis sinensis after regular anthelmintic treatment. Conclusion If bile duct exploration finds grey- black or bright- red melon seed-like floccules,clonorchiasis should be highly suspected. Intraoperative T- tube drainage is recommended,and if suspected Clonorchis sinensis is found after laparoscopic bile duct exploration and T- tube drainage or after ERCP and nasobiliary drainage,microbiological examination should be performed next. As for the patients with a definite diagnosis of clonorchiasis,they should not eat uncooked freshwater fish or shrimps and should be given regular anthelmintic treatment.
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