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肝吸蟲으로 因한 膽道炎 Liver Fluke-induced Cholangiohepatitis

대한외과학회지 1971년 13권 2호 p.1 ~ 8
조중행, 이영, 오수명, 최성숙,
소속 상세정보
조중행 (  ) 
서울대학교 의과대학 외과학교실

이영 (  ) 
서울대학교 의과대학 외과학교실
오수명 (  ) 
서울대학교 의과대학 외과학교실
최성숙 (  ) 
서울대학교 의과대학 외과학교실

Abstract


Surgical complication of Clonorchis sinesis, though frequent in incidence and troublesome in
management, was rarely discussed in Korean literature.
The clinical features of 15 cases of liver fluke-induced cholangiohepatitis, experienced at the
Dep´t of General Surgery, SNUH are described and related papers were reviewed especially for
comparison of the obtained data with recurrent pyogenic cholangiohepatitis of Hong Kong.
The analysis showed following results.
1) Liver fluke induced cholangiohepatitis occupied 4.3% of all the surgical diseases of hepatobiliary
system at the Dep´t of General Surgery in SNUH during the 30 months (Jan. 1968-Oct. 1970).
Characteristically 80% of the reported 15 patients were male and the cholangiohepatitis due to liver
fluke affected 26 years to 60 years in our series, the peak incidence being the 5th and 6 th decade.
2) There was ni remarkable difference in clinical and laparotomy findings with so-called "Hong
Kong Syndrome".
3) Liver fluke-induced cholangiohepatitis should be suspected in every patient under relatively
poor general condition with hepatomegaly, eosinophilia and positive stool for ova of Clonorchis
sinensis in addition to the 3 charateristic symptoms of RUQ pain, fever and jaundice.
4) The post-operative hospital mortality was 13% (2 cases) whose causes of death were cardiac
arrest of unknown origin and hepatic coma due to associated hepatoma, respectively.
5) The methods of treatment in our series were as follows; cholecystectomy and T-tube insertion
in 10 cases, Cholecystojejunostomy with jejuno jejunostomy and transduodenal sphincterotomy in 1
case, cholecystectomy and sphicterotomy in 1 case, CBD exploration with T-tube insertion in 1
case, sphinterotomy with T-tube insertion in 1 case and liver biopsy in 1 case.
6) In spite of incomplete follow-up data, it could be said that relatively peaceful post-operative
course was observed in the 7 patients who had no typical previous biliary obstruction in history
and laboratomy findings. But in the remaining 8 cases with prominent biliary obstruction there
was prolonged post-operative drainage of the adult worms, biliary mud and debris with signs of
intermittent biliary obstruction. According to the result and the review of the foreign literature,
Choledochoduodenostomy or sphincteroplasty should be recommended for the liver fluke-induced
cholangiohepatitis with prominent biliary obstruction.

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