Direct Cholangiographic Features and Therapeutic Methods of Biliary Ascariasis

膽道蛔蟲症之直接膽管造影特徵及治療

柯成國(Chen-Guo Ker) ； 黃宗人(Tsung-Jen Huang) ； 沈柏青(Pai-Ching Sheen) ； 王良彥(Liang-Yen Wang) ； 詹昌明(Chang-Ming Jan) ； 劉宏文(Hong-Wen Liu) ； 張文宇(Wen-Yu Chang) ； 陳章義(Chang-Yi Chen) ； 陳瑩霖(Eng-Rin Chen) ； 林國正(Guo-Jen Lin) ； 阮仲垠(Chung-)

《The Kaohsiung Journal of Medical Sciences》 1卷6期 (1985/06) Pp. 334-342

https://doi.org/10.6452/KJMS.198506.0334

摘要

在二十年以前蛔蟲症在本省是常見的寄生蟲疾病，當時膽道蛔蟲之X光學膽管造影診斷，只限於靜脈注射膽管造影而已，但於近數年來，因直接膽管造影已相當發達，可清楚地指出膽管型態，然而近數年來蛔蟲症也已大大地減少了，所以臨床上以直接膽管造影來診斷膽道蛔蟲症只限於偶然的病例報告而已，本文收集三家醫院之病例並分析報告。
共有14例膽道蛔蟲用直接膽管造影法診斷。直接膽管造影包括經皮穿肝膽造影（PTC），逆行性內視鏡胰膽管造影（ERCP）及術後膽管造影（POC）。其蛔蟲位置可分（1）肝內膽管，有5例（35.7%）（2）肝外膽管，有9例（64.3%），這些病例男女比率為3比11，肝內膽管蛔蟲症中3例，合併有膽石存在，且4例合併有阻塞性黃疸，但肝外性蛔蟲病中只有一位合併膽囊結石，另一例合併阻塞性黃疸，在臨床表徵觀察分析，以肝內蛔蟲比肝外蛔蟲症較嚴重，而且肝內蛔蟲即存在肝內膽管內而造成膽管炎及敗血症而死亡，肝外型蛔蟲症無合併膽管狹窄之病例發現。
為了避免肝外蛔蟲變成肝內型蛔蟲症，而造成肝內部膽管狹窄，使蛔蟲無法回轉排入十二指腸引起嚴重膽管炎而治療困難，原則上，在直接膽管造影發現有蛔蟲時，可以用內視鏡方法將總膽管內蛔蟲挾出，若失效，則考慮手術治療。

並列摘要

The diagnosis of biliary ascariasis was chiefly made by intravenous cholangiograpahy before operation in the past. At that time, differential diagnosis of biliary ascariasis from other biliary disorders was difficult because the direct cholangiography was not established yet.
Fourteen patients of biliary ascariasis had been diagnosed by direct cholangiography including PTC 3 cases, ERCP 10 cases and post-operative cholangiography 1 case. According to the location of worms, it could be classified into (i) intrahepatic group 5 cases (35.7%) and (ii) extrahepatic group 9 cases (64.3%).
Sex distribution disclosed male to female of 3 to 11. Combination of ductal stones and obstructive jaundice occurred in 60% (3 cases) and 80% (4 cases) respectively in the intrahepatic group.
In fact, the clinical manifestation is much severer in the intrahepatic group than in the extrahepatic group. Stenosis of hepatic duct was observed in 4 of 5 cases in the intrahepatic group but none in the extrahepatic group. Surgery is undertaken while the possibility of cholecystocholangitis or other complications are manifested with persisting high fever and jaundice. If the biliary ascaris still presented 2 weeks after cholangiographic study, surgery would also be considered.

並列關鍵字

ascariasis ； direct cholangiography ； cholangitis