超声诊断肝吸虫病性胆道梗阻患者临床研究

目的分析和总结肝吸虫病性胆道梗阻的超声检查表现及其对临床治疗的指导价值。方法2012年1月~2018年11月我院消化内科和普外科收治的30例肝吸虫病性胆道梗阻患者,均接受超声检查。给予患者吡喹酮正规治疗,对驱虫治疗后仍存在胆道梗阻者,行内镜下胆总管切开手术治疗。结果肝吸虫病性胆道梗阻患者胆管管壁增厚,肝内胆管扩张程度均严重,常合并胆总管病变;本组吡喹酮治疗成功率为63.3%,11例接受手术治疗,均获得成功;治疗前,本组患者血清总胆红素、天冬氨酸氨基转移酶和丙氨酸氨基转移酶水平分别为(56.1±13.9)μmol/L、(151.2±67.8)U/L和(74.3±30.7)U/L,治疗后恢复到【(13.3±1.3)μmol/L、(91.5±39.2)U/L和(32.7±14.3)U/L,P<0.05】;术后,4例患者发生急性胰腺炎,5例患者出现高淀粉酶血症。经2~10 d治疗,均治愈。结论肝吸虫病性胆道梗阻的早期超声诊断以管壁增厚和肝内胆管扩张为特点,结合病史,可以帮助诊断。吡喹酮治疗肝吸虫病效果较好。对于胆道梗阻,采取内镜下介入治疗,效果肯定。

Ultrasoundmanifestation of hepatic distomiasis and its clinical outcomes: An analysis of 30 cases

Objective The aim of this study was to summarize the ultrasound manifestation of hepatic distomiasis and its clinical outcomes. Methods 30 patients with hepatic distomiasis and common bile duct obstruction were included in this study, and all came from the Department of Gastroenterology and General Surgery in our hospital between January 2012 and November 2018. All patients underwent ultrasonography, and the patients received praziquantel for treatment, and some of them received endoscopic retrograde cholangiao-pancreatography (ERCP) for bile duct obstruction after praziquantel therapy. Results The ultrasound manifestation of patients with hepatic distomiasis were the thickness of bile duct walls and intrahepatic bile duct dilation, often with common bile duct diseases; the successful rate by praziquantel therapy was 63.3%, and eleven patients received ERCP, all successful; at presentation, serum bilirubin, aspartate aminotransferase and alanine aminotransferase levels were (56.1±13.9)μmol/L, (151.2±67.8)U/L and (74.3±30.7)U/L, and all improved after treatment or operation 【(13.3±1.3)μmol/L, (91.5±39.2)U/L and (32.7±14.3)U/L, respectively, P<0.05】; post-operationally, acute pancreatitis developed in four patients and blood hyperamylase developed in five patients, and all recovered after two to ten day internal interventions. Conclusion The ultrasound features of hepatic distomiasis and biliary obstruction is characterized by thickening of the bile duct walls, and dilatation of intrahepatic bile ducts. The praziquantel treatment is efficacious in most patients and the intervention of ERCP also has a good outcomes in patients with bile duct obstruction and dilatation.