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膽道內 蛔蟲迷立證 37例에 對한 臨床的 考察

Clinical Observation on Biliary Ascariasis

대한외과학회지 1970년 12권 5호 p.55 ~ 62
강기철, 윤기호, 이종균,
소속 상세정보
강기철 (  ) - 춘해병원 외과
윤기호 (  ) - 춘해병원 외과
이종균 (  ) - 춘해병원 외과

Abstract


Clinical studies on 37 surgical with biliary ascariasis who were admitted to the Department
of Surgery, Choon Hae Hospital from July, 1963 to December, 1969 were presented. The results were
summarized as follows;
1) The percentage ratio of biliary ascariasis to the total numbers of biliary surgical patients during
this period was 20.7%.
2) The ratio male to female of the patients was 1:1.6 and predominant age incidence was the
4th decade of life, with female cases accounting for 30% in this decade.
3) The chief complaint was severe spontaneous epigastric pain which tend to radiate to other
places. Neusea and/or vomiting was noticed in 23 of 37 cases, but fever, jaundice, muscular guarding
and palpable mass were not remarkable.
4) Clinical diagnosis was obtained in 20cases(54.3%) before operation; 3o of them were confirmed
by means of I.V Cholangiogram showing ascaris shadows.
5) During the operation, ascaris were found in the common bile duct in 35 cases, right hepatuc
duct in one cases and sphincter Odii in one case as a nucleus of stone.In 25(67.6%) of 37 cases,
ascaris was alive. Invasion by single ascaris was seen in 32 cases and by two ascaris in 4, in remaining
one cases 3 ascrides were seen. Stome was coexist in 7 of the 37 cases.
6) Cholangiogram may visualize on patient who had intact gallbladder with small ascaris in it, and
may not visualize on cases which was impacted by big ascaris.
7) Four cases had 20 years in duration of past history without stone; two of them were found
with living ascaris, and because of the ascaris could not be alive so long duration, these two cases
of livinf ascaris seemed to be reinvaded.
8) Auther beleive that the motive of ascaris invasion would be due to the habit of ascaris entering
small holes than any other reasons.
9) The tendency to increasing pain after taking meals seemded to be caused by more increased active
motion of the ascaris which was activated by increased bile excreation. and their action would stim
mulate reflex of the biliary tract and the reason uncontrolled pain with the analgesics woud not be
difficult to suppose that the analgesics would not act on ascaris.
10) In patiens who had rather continuous epogastric pain and/or also had pain on right lower
abdomen should be checked the appendix after found ascaris in biliary tract. Author had an experience
one case of invaded ascaris in common bile duct and appendix coincidentaly.
11) Author gave anthemintics in many patients on 4 to 5th postoperative day and it seemed to
prevent reinvasion effectively.

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