摘要
目的 探讨内镜下逆行胰胆管造影 (ERCP)和乳头括约肌切开术 (EST)对华支睾吸虫病诊断和治疗的价值。方法 胆汁中找到华支睾吸虫成虫或虫卵的 6 2例作为诊断观察组 ,其中 4 7例伴梗阻性黄疸者行EST ,为EST组 ;同期行ERCP检查的 12 83例非华支睾吸虫病患者为诊断对照组 ;同期 34例因单纯华支睾吸虫性梗阻性黄疸手术者为外科手术组。结果 6 2例华支睾吸虫病患者全部有弥漫性肝内胆管末端囊性扩张 ,而非华支睾吸虫病患者无一出现此征象。EST组治疗后 1～ 2周 ,胆总管平均直径和血清总胆红素、碱性磷酸酶、γ GT均明显降低。EST和外科手术的治疗有效率及并发症发生率差异无显著性 ,但EST组需输血人数、平均住院日和平均费用却明显低于外科手术组。结论 对临床怀疑华支睾吸虫病的患者 ,如果传统方法不能确诊 ,应行ERCP检查 ,其影像学特征是弥漫性肝内胆管末端囊性扩张 ,同时可抽吸胆汁检测华支睾吸虫成虫或虫卵 ,对出现梗阻性黄疸者 ,EST应作为首选的治疗手段。
Objective To assess the value of endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy (EST) for diagnosis and treatment of clonorchiasis sinensis. Methods Sixty-two patients with clonorchiasis sinensis, imagoes or eggs of which were seen in their bile, were assigned to diagnostic observing group. Among them, 47 patients who were treated by EST due to obstructive jaundice were as therapeutic observing group (EST group). Meanwhile 1 283 patients who underwent ERCP due to other suspected cholangiopancreatic abnormalities were assigned to diagnostic control group. Thirty-four patients who were treated by surgical operation due to obstructive jaundice caused by clonorchiasis sinensis were as therapeutic control group (surgery group). Results Diffuse saccular dilation of terminal intrahepatic bile duct occurred in all the patients with clonorchiasis sinensis, but none in patients with other cholangiopancreatic abnormalities. About 1 to 2 weeks after EST, the average diameter of bile duct and serum total bilirubin, ALP, γ-GT were decreased significantly in 47 patients in EST group. The rates of therapeutic effectiveness and complications were similar between surgery and EST groups, but the number of patients requiring blood transfusion, the average hospitalization days and the average cost were must lower in EST group than in surgery group.Conclusions The diffuse saccular dilation of terminal intrahepatic bile duct is a highly specific feature of clonorchiasis sinensis, and ERCP is useful for its diagnosis. EST is a cost-effective therapy for the patients with clonorchiasis sinensis complicated by obstructive jaundice.
出处
《中华消化杂志》
CAS
CSCD
北大核心
2003年第5期279-281,共3页
Chinese Journal of Digestion
关键词
华支睾吸虫病
逆行胰胆管造影
乳头括约肌
切开治疗
梗阻性黄疸
Clonorchiasis sinensis
Obstructive jaundice
Endoscopic retrograde cholangiopancreatography
Endoscopic sphincterotomy
