- 期刊
水蛭侵染人類鼻腔－五例報告
Nasal Leech Infestation in Man – Report of Five Cases
摘要
台灣公共衛生的進步使得水蛭侵染人類鼻腔已不多見。過去在國內僅偶有少數個案報告。它常見的入侵途徑是接觸含水蛭的水，如飲生水或在溪、池畔洗臉，戲水等，而使其進入鼻腔。水蛭侵染鼻腔會有流鼻血、鼻塞、異物感等症狀。本文報告5例病例，他們均以流鼻血為主訴，追溯病史都表示兩三週前曾赴溪邊戲水或飲生水。有2例需以鼻內視鏡確定診斷。治療方面：3例以麻醉藥噴霧後順利取出，另2例在全身麻醉下才得以夾除。水蛭以其3個帶利齒的顎在人體黏膜上切開1個Y型傷口吸血，並分泌水蛭素（hirudin）及其他物質以防止血液凝固。對流鼻血的患者，病史詢問及必要的內視鏡檢查相當重要，各種可能的鼻腔異物，包括水蛭在內，是不能忽略的鑑別診斷。本科最近半年中即連續診治3例，是否與週休2日，往郊區溪邊戲水渡假的人數增加有關，是值得更進一步探討的公共衛生問題。
並列摘要
Nasal leech infestation is usually through contact with water containing leeches when drinking, face-washing, or swimming. Thus the entry of leeches into the nasal passage can easily go unnoticed. Nasal infestation of leeches results in epistaxis and occasional foreign body sensation. We present five patients with nasal leeches complaining of recurrent epistaxis. Tracing their history, all had either swum in the ponds or drunk untreated fresh water 3 or more weeks age. In three patients the leeches were removed after lidocaine and ephedrine nasal spray in the outpatient depart-ment. The remaining two needed general anesthesia for either endoscopic removal or electric shock of leeches by bipolar cautery before removal. Leeches have three toothed jaws which protrude through their mouth and make a typical Y-shaped wound on skin or mucosa. Their salivary glands secrete a kind of anticoagulant called hirudin, as well as substances which have the effect of vasodilation and anesthesia. When treating epistaxis, a variety of nasal “foreign bodies” should not be overlooked. Due to the progress in public health and education, nasal leech infestation in Taiwan should have been rare in recent years. However, we found that three of the five cases occurred within the past half year, and most of them had ever played in the water. As the population has adjusted to the 2-day weekends, it has become popular to visit rural areas on the weekends. Thus the incidence of leech infestation may be on the increase. It is neces-sary to prevent contact with leeches during recreation. Leech infestation can be avoided by drinking only boiled water or at least inspecting the water before swallowing.