Harinasuta T, Riganti M, Bunnag D
Arzneimittelforschung. 1984;34(9B):1167-9.
The pathological changes are more or less related to the intensity and the duration of the infection, and are commonly seen in older patients with a large number of flukes. The pathogenesis is due to the mechanical irritation by the flukes and some toxic substances produced by them. Lesions are mainly confined to the biliary system. There is hyperplasia of the epithelial cells lining the bile ducts. In heavy and severe infections there are obstruction of the biliary tract, bile retention, extensive hyperplasia of the biliary system, with glandular proliferation of papillomatous and adenomatous type, cholangitis, periductal infiltration with eosinophils, round cells and fibrosis in the portal areas, necrosis and atrophy of hepatic cells. The bile ducts are dilated and in late cases saccular or cystic formations may develop into large cysts. The gallbladder may enlarge and contain white bile. The liver profile is generally normal. The majority of cases are symptomless. Clinical features vary from mild to severe. The symptoms and signs are vague gastro-intestinal symptoms, flatulence, anorexia, lassitude, weight loss, dull pain at the right hypochondrium, hot cutaneous sensation of the abdomen, and enlargement of the liver with some tenderness. In few cases the manifestations are severe. There is relapsing cholangitis, the patient is seriously ill and may succumb to septic shock. Cholangiocarcinoma, gallstones and obstructive jaundice are not unusual associations.
病理变化或多或少与感染的强度和持续时间有关，常见于感染大量吸虫的老年患者。发病机制是由于吸虫的机械刺激及其产生的一些有毒物质。病变主要局限于胆道系统。胆管内衬上皮细胞增生。在重度感染时，会出现胆道梗阻、胆汁潴留、胆道系统广泛增生，伴有乳头状和腺瘤样腺体增生、胆管炎、门静脉区域嗜酸性粒细胞、圆形细胞浸润及纤维化、肝细胞坏死和萎缩。胆管扩张，晚期可形成囊状或囊性结构，发展为大囊肿。胆囊可能增大并含有白色胆汁。肝脏外形一般正常。大多数病例无症状。临床特征从轻微到严重不等。症状和体征为模糊的胃肠道症状、肠胃气胀、厌食、乏力、体重减轻、右季肋部隐痛、腹部皮肤有热感以及肝脏肿大并有压痛。少数病例表现严重。会出现复发性胆管炎，患者病情严重，可能死于感染性休克。胆管癌、胆结石和梗阻性黄疸并不少见。
