Fang K M, Yen C L, Chen C L
Department of Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan, R.O.C.
Changgeng Yi Xue Za Zhi. 1993 Jun;16(2):105-10.
From January 1982 to September 1987, ten diagnosed cases of biliary ascariasis were collected among 8,160 cases who were admitted for biliary tract diseases in our hospital. It represented an incidence of 0.12% in our hospital. In our series, the patients' ages ranged from 33 to 68 years old, with a female predominances. The clinical impression on admission were those of biliary tract stone, infection or pancreatitis. Signs and symptoms of biliary ascariasis were abdominal pain, fever, jaundice, vomiting of round worms and distended gallbladder. Laboratory findings disclosed leukocytosis, mildly elevated alkaline phosphatase, transaminase and bilirubin. There was a relatively high incidence of positive bile culture for bacteria. The reliable diagnostic tools for biliary ascariasis were abdominal real-time ultrasonography and endoscopic retrograde cholangiopancreatography (ERCP). They yielded a diagnostic rate of 40% and 87.5% respectively in our series. The principles of management of biliary ascariasis were conservative treatments including intravenous fluids, nasogastric decompression, antibiotics and antihelmintic agents. Other treatments that were also tried included endoscopic removal of round worms through a T-tube, or nasobiliary drainage. Surgery was considered when there were signs of complications, such as uncontrolled sepsis or suppurative cholangitis. The prognosis of biliary ascariasis was good if patients were diagnosed and treated properly. Regular follow-up with antihelmintic agents is also recommended to avoid reinfection.
1982年1月至1987年9月，在我院收治的8160例胆道疾病患者中，收集到10例确诊的胆道蛔虫病病例。我院的发病率为0.12%。在我们的病例系列中，患者年龄在33至68岁之间，女性居多。入院时的临床诊断印象为胆道结石、感染或胰腺炎。胆道蛔虫病的体征和症状为腹痛、发热、黄疸、呕吐蛔虫和胆囊肿大。实验室检查发现白细胞增多、碱性磷酸酶、转氨酶和胆红素轻度升高。胆汁细菌培养阳性率相对较高。胆道蛔虫病可靠的诊断工具是腹部实时超声检查和内镜逆行胰胆管造影（ERCP）。在我们的病例系列中，它们的诊断率分别为40%和87.5%。胆道蛔虫病的治疗原则是保守治疗，包括静脉输液、鼻胃管减压、抗生素和驱虫剂。还尝试了其他治疗方法，包括通过T管内镜取出蛔虫或鼻胆管引流。当出现并发症迹象，如败血症无法控制或化脓性胆管炎时，考虑手术治疗。如果患者得到正确诊断和治疗，胆道蛔虫病的预后良好。还建议定期使用驱虫剂进行随访，以避免再次感染。
