肝癌合并华支睾吸虫病的术中诊断及处理

目的总结肝癌合并华支睾吸虫病的术中诊断及处理方法。方法对78例肝癌合并华支睾吸虫病患者的术中所见及处理方法作回顾性分析。结果本组术中均于肝切面上或切除后胆管中肉眼见华支睾吸虫成虫,行肝癌切除术同时行胆总管切开探查,胆管冲洗取虫、T管引流,术后抗吸虫药物治疗。术后发生胆瘘10例,经处理治愈7例,死于胆瘘感染3例;死于肝功能衰竭2例。余患者1个月后复查肝功能恢复正常,大便检查无虫卵。结论华支睾吸虫疫区的肝癌患者术中应注意吸虫病后诊断;肝癌切除后胆管冲洗取虫、T管引流及术后抗吸虫治疗为有效方法。     

华支睾吸虫病合并胆结石胆囊炎1例分析

目的了解1例患者出现华支睾吸虫病、胆结石、胆囊炎三联症的有关发病原因与临床表现,分析有关发病因素。方法直接涂片法检查患者T型管引流液中华支睾吸虫卵,kato-katz法检查粪便中华支睾吸虫卵,吡喹酮驱虫药物治疗。结果无论肉眼或镜下对患者T型管引流液中排出的虫体经鉴定结果一致,均为华支睾吸虫成虫。对患者采用吡喹酮总量120 mg/kg体重,3 d分服9次服完的驱虫治疗与对症处理的治疗方案,经治疗半月、1月、3月复查与回访,临床症状与体征消失,治后半月、1月及3月的粪便均未再检获华支睾吸虫卵。结论该患者出现的华支睾吸虫病、胆结石、胆囊炎三联症为有华支睾吸虫病的流行或有发病的地区所少见。     

急性胆囊炎手术患者合并华支睾吸虫感染1例

患者男性，43岁，2008—07-19因右上腹疼痛入南通市某医院治疗，诊断为急性结石性胆囊炎、阻塞性黄疸，实施胆囊切除＋胆道探查＋术中胆道造影＋T管引流术，术中发现胆管中有华支睾吸虫，T管引流胆汁中可见寄生虫，嘱抗寄生虫治疗。患者出院后，于8月4日入南通市疾病预防控中心行病原治疗，采取口服吡喹酮总剂量120mg／kg，每日3次，     

吡喹酮治疗华支睾吸虫病胆总管T型引流观察

华支睾吸虫病（又称肝吸虫病）是一种严重危害人体健康的人兽共患寄生虫病，食人合该虫囊蚴的生鱼是本病的主要感染方式。以往文献中，观察吡喹酮治疗华支睾吸虫病的疗效，多以粪便虫卵定性、定量试验方法，间接地反应虫体驱出情况，而直接观察虫体排出的文献甚少。本文通过对2例行胆囊切除术并伴有华支睾吸虫病的患者应用毗隆酮治疗，自胆总管T型管引流中直接观察了虫体排出情况，现报告如下。观察对象和方法例1：齐XX，男，36岁，农民，以急腹症人院，在剖腹探查术中发现有华支睾吸虫病合并慢性胆囊炎，致胆总管堵塞，行胆囊切除术，疏…     

吡喹酮治疗急、慢性猫后睾吸虫病的首次报道

近年文献报道,吡喹酮治疗支睾吸虫病及麝猫后睾吸虫病的疗效甚高、耐受性亦好。但对猫后睾吸虫病的疗效尚无报导。作者证明吡喹酮对猫后睾吸虫病也有很高疗效。作者用吡喹酮治疗猫后睾吸虫病患者18例,其中急性期8例,慢性期10例。吡喹     

华支睾吸虫病的逆行胰胆管造影和乳头括约肌切开治疗

目的 探讨内镜下逆行胰胆管造影(ERCP)和乳头括约肌切开术(EST)对华支睾吸虫病诊断和治疗的价值。方法 胆汁中找到华支睾吸虫成虫或虫卵的62例作为诊断观察组，其中47例伴梗阻性黄疸者行EST，为EST组；同期行ERCP检查的1283例非华支睾吸虫病患者为诊断对照组；同期34例因单纯华支睾吸虫性梗阻性黄疸手术者为外科手术组。结果62例华支睾吸虫病患者全部有弥漫性肝内胆管末端囊性扩张，而非华支睾吸虫病患者无一出现此征象。EST组治疗后1～2周，胆总管平均直径和血清总胆红素、碱性磷酸酶、γ—GT均明显降低。EST和外科手术的治疗有效率及并发症发生率差异无显著性，但EST组需输血人数、平均住院日和平均费用却明显低于外科手术组。结论 对临床怀疑华支睾吸虫病的患者，如果传统方法不能确诊，应行ERCP检查，其影像学特征是弥漫性肝内胆管末端囊性扩张，同时可抽吸胆汁检测华支睾吸虫成虫或虫卵，对出现梗阻性黄疸者，EST应作为首选的治疗手段。     

总胆管引流观察吡喹酮治疗华支睾吸虫病的效果

吡喹酮治疗华支睾吸虫病的效果,国内外已有报道,认为该药疗效好,反应轻,优于其它药物。本文报告一例胆总管T型管引流观察吡喹酮治疗华支睾吸虫病的效果。 患者,男性,因右上腹持续疼痛,阵发性加剧伴恶心、呕吐4小时,入我院外科。检查:体温37.7℃,     

吡喹酮成功地治疗了15例吸虫病和绦虫病患者

作者用吡喹酮治疗了15例病人:华支睾吸虫病4例,横川后殖吸虫病5例,卫氏并殖吸虫病1例,阔节裂头绦虫病4例和牛肉绦虫病1例。4例华支睾吸虫病患者每克粪便虫卵数(EPG)为20000～1000个,其中3例口服吡喹酮的总剂量为75mg/kg,分3次服,每4小时服1次;另1例患者的剂量为     

171例华支睾吸虫病患者临床资料分析

目的了解171例华支睾吸虫病病例的临床特征。方法对确诊的华支睾吸虫病患者的临床资料、实验室和B超影像学检查及再感染情况等进行描述分析。结果 171例患者多数无明显症状或仅有轻度乏力、肝区不适等症状,病情较轻,其中无不适症状者占58.33%(99/171),出现乏力、食欲减退者占42.11%(72/171);肝功能异常发生率为57.31%(98/171);122例进行了B超检查,发现合并胆囊炎8例,胆囊结石3例,肝内胆管回声增强35例,肝内胆管回声增强并肝内胆管轻度扩张42例,脂肪肝10例;再感染发生率高,24例经吡喹酮后,有22例华支睾吸虫虫卵和/或华支睾吸虫抗体阳性;再感染者中肝内胆管轻度扩张发生率为68.18%(15/22),未经治疗患者发生率为27.55%(27/98),差异有统计学意义(χ2=10.43,P<0.01)。结论华支睾吸虫病多数患者无明显症状或仅有轻度乏力、肝区不适等症状,病情轻;再感染发生率高,且肝内胆管扩张发生率较高。     

鼻胆管代替T型管引流在胆道外科手术中的应用研究

对125例胆石症患者行手术治疗,其中60例术后采用T型管引流（T管组）,65例采用自制的鼻胆管引流（鼻胆管组）,两组均经术后胆道造影拔管,结果鼻胆管组与T型管组比较,术后拔管及胆汁引流明显明显缩短,P均＜0．05,术后住院天数明显缩短,P＜0．05,术后与引流相关的并发症发生率低,P＜0．05,认为胆道外科术后采用鼻胆管引流能够缩短患者住院时间,避免胆汁大量丢失,并发症少,避免了长期带T管的痛苦。胃肠功能恢复快,有利于早期康复,是一种较为理想的引流方式。     

Treatment of severe Clonorchiasis sinensis by endoscopic nasobiliary drainage and oral praziquantel

AIM: To assess the therapeutic value of endoscopic nasobiliary drainage (ENBD) and oral praziquantel for severe Clonorchiasis sinensis infection.METHODS: Of the 84 Clonorchiasis sinensis-infected patients enrolled, 58 were treated with ENBD (as observing group, ENBD group), 26 received operations (control group,operation group). Both of the two groups were comparable in terms of patient‘s age, body mass index. Before and one week after treatment, the average diameters of common bile ducts were measured by ultrasound, andserum bilirubin, ALP,γ-GT and ALT were detected by biochemical methods, After ENBD or operation, the patients took praziquantel for two days. RESULTS: Compared with the patients in operation group,ENBD patients in ENBD group had higher recovery rates of abdominal pain and fever as well as jaundice, quicker remission,smaller trauma, fewer complications and lower cost.CONCLUSION: ENBD combined with oral praziquantel is an effective and safe method for the treatment of severe Clonorchiasis sinensis.     

Little effect of praziquantel or artemisinin on clonorchiasis in Northern Vietnam. A pilot study

The first choice for treatment of Clonorchis sinensis infections is praziquantel. Experimental data suggest that artemisinin derivatives are active against C. sinensis. The efficacy of both drugs against clonorchiasis was evaluated in a pilot study in clonorchiasis patients in an endemic area in the North of Vietnam. Twenty-one patients received praziquantel 25 mg/kg o.d. for three days, the regular regimen in that area, and 21 patients were treated with artemisinin 500 mg b.i.d. for 5 days. Faecal egg counts were performed before as well as 6 days and 5 weeks after treatment. In the praziquantel group the faecal egg count decreased significantly from a mean value of 1632 eggs per gram faeces (epg) to 37 epg 5 weeks after treatment (P < 0.01) but, surprisingly, the eradication rate (95% confidence limit) at week 5 was only 29% (11-52%). In the artemisinin-treated group the reduction of the egg count was insignificant: from 1103 to 542 epg (P > 0.05). The proportion of patients (95% c.l.) with C. sinensis eggs in their stool on week 5 was 90% (70-99%) in the artemisinin group and 71% (48-89%) in the praziquantel group (P > 0.05) and the eradication rate (95% c.l.) at week 5 was only 10% (1-30%). With a sensitivity of detection of eggs in stool > 0.89, this implies a statistically significant but clinically unsatisfactory reduction for treatment with praziquantel. Sensitivity is probably less. For artemisinin there was no significant reduction. In conclusion, for human clonorchiasis in the North of Vietnam, the efficacy of praziquantel 25 mg/kg o.d. for 3 days was unsatisfactory and artemisinin for 5 days is not an effective alternative.     

Artemether, artesunate, praziquantel and tribendimidine administered singly at different dosages against Clonorchis sinensis: a comparative in vivo study

We comparatively assessed the in vivo efficacy of artemether, artesunate, praziquantel and tribendimidine against different stages of Clonorchis sinensis. Rats were infected with 40-50 C. sinensis metacercariae, and drugs were administered singly by the oral route at different dosages. Rats were dissected 2-4 weeks post-treatment and C. sinensis trematodes were removed from the liver and bile ducts and counted. We used a negative binomial regression model to test the effect of drug and dosage in terms of worm burden reduction. Single 150 mg/kg oral doses of artesunate, artemether, tribendimidine and praziquantel, administered to rats infected with adult C. sinensis, resulted in mean worm burden reductions of 100, 100, 89.5 and 80.7%, respectively (all P<0.001). Halving the dose to 75 mg/kg still resulted in highly significant worm burden reductions for artesunate, artemether and tribendimidine (71.4-100%), but not for praziquantel (20.7%). In the juvenile infection model, a single 150 mg/kg oral dose of tribendimidine and praziquantel resulted in mean worm burden reductions of 99.1 and 90.0%, respectively, whereas considerably lower reductions were observed for artemether (59.2%) and artesunate (57.6%) when used at the same single dose. The in vivo results presented here with the artemisinins and tribendimidine provide further data for clinical investigations to assess the safety and efficacy of these drugs in clonorchiasis patients.     

Determination of the minmum effective dosages of praziquantel, albendazole, and mebendazole against Clonorchis sinensis infection in rats

In order to determine the minimum effective dosages of praziquantel, albendazole, and mebendazole against Clonorchis sinensis infection in Sprague-Dawley rats, each rat was infected with 30 metacercariae and treated with one of three drugs. The rats were killed and examined 25 days after praziquantel treatment or 11 days after albendazole or mebendazole treatment. The minimum effective dosages were a single dose of praziquantel 375 mg/kg, albendazole 150 mg/kg, and mebendazole 150 mg/kg. Trials are required to determine whether these dosages are useful in the treatment of human clonorchiasis.     

华支睾吸虫病88例流行病学和临床特征分析

目的 研究华支睾吸虫病患者的流行病学和临床特征.方法 对哈尔滨医科大学附属第二医院2002至2004年收治88例华支睾吸虫病患者的流行病学资料、临床表现、实验室检查、治疗情况进行回顾性分析.结果 有进食生的或半生的淡水鱼(虾)史的患者占68.2%,22.6%的患者职业为厨师、喂鱼员、钓鱼爱好者、鱼贩,9.1%的患者传播途径未明.88例患者中,上腹疼痛53例,占60.3%;乏力46例.占52.3%;腹泻29例,占33.0%;食欲减退61例,占69.3%;黄疸21例,占23.9%;肝脏肿大52例,占59.1%;脾脏肿大7例,占8.0%;头晕18例,占20.9%;发热5例.占5.7%;胆绞痛13例,占14.8%;28.4%的患者无症状.嗜酸粒细胞增多61例,占69.3%;肝功能异常62例,占70.4%.吡喹酮、丙硫咪唑治疗组的粪便虫卵阴转率分别为91.9%,86.5%(χ2=0.561,P=0.454).结论 华支睾吸虫病临床表现复杂、多样,常出现肝功能异常,易误诊,值得重视.     

三苯双脒治疗华支睾吸虫病的效果观察

目的 观察三苯双脒抗华支睾吸虫的临床疗效,为治疗华支睾吸虫病的药物选择提供依据。方法 采用分层随机抽样,将2020年8月—2022年8月南宁市武鸣区疾控中心门诊治疗的华支睾吸虫感染患者分为采用三苯双脒治疗的试验组和采用吡喹酮治疗的对照组,其中试验组分A、B、C三组：A组为单剂次顿服;B组为2剂次隔周顿服;C组为3剂次连续3日顿服。每剂次剂量均为400 mg。对照组(D组)使用吡喹酮治疗,每日3次,800 mg/次,连服3日。治疗一个月后复诊复检,观察治疗前后虫卵变化及药物不良反应,评定治疗效果。结果 三苯双脒试验组149例,其中A组45例,B组51例,C组53例;吡喹酮对照组99例。试验组A、B、C各组虫卵阴转率分别为86.67%、94.12%和92.45%;对照组虫卵阴转率为97.98%。各组间虫卵阴转率差异无统计学意义(χ²=7.146,P>0.05)。轻度感染患者试验组A、B、C各组虫卵减少率分别为79.27%、88.47%和82.11%,对照组为87.91%;中度感染患者试验组各组虫卵减少率分别为78.86%、97.43%和98.65%,对照组为99...     

ERCP在胆道外科治疗中的应用

目的探讨ERCP在胆道外科治疗中的应用价值。方法回顾性分析近3年（2003年1月至2006年1月间）胆道术后残余结石及再生结石行乳头括约肌切开取石122例,腹腔镜胆囊切除术（LC）术后胆瘘行鼻胆管引流（ENBD）13例,原位肝移植术后胆管狭窄行胆管球囊扩张,放置胆管内支架或鼻胆管引流6例。结果122例胆道术后残余结石及再生结石患者经十二指肠镜胆道造影（ERC）成功率95.9%,取石成功率91.5%,其中有5例经2次操作取尽结石。13例胆瘘患者经鼻胆管引流2～3周后,胆瘘处均闭合,无严重并发症发生。6例胆管狭窄患者经ERC胆道介入（球囊扩张、ENBD或内支架）均治愈。结论ERCP在胆道外科治疗中具有重要应用价值,是术后残余结石或再生结石、术后胆瘘及术后胆管狭窄的有效介入方法。     

Social and behavioral factors associated with Clonorchis infection in one commune located in the Red River Delta of Vietnam

Social behavioral factors associated with Clonorchis infection are needed for control measures. The population in Nga Tan commune were randomly sampled and questioned to determine knowledge, perception, and health behavioral factors associated with Clonorchis infection among heads of households. The cellophane thick smear method was applied to examine their stool samples. Seven hundred and seventy-one cases were examined, the positive rates were 17.2%, 66.9%, 78.7%, 15.9%, and 0.14% for Clonorchis sinensis, Ascaris lumbricoides, Trichuris trichiura, hookworm, and Dicrocoelium dendriticum respectively. There was no significant difference between the infection rate of clonorchiasis, education level, and family income groups (p > 0.05). But there was significance difference between the infection rate of clonorchiasis and people living in different family sizes (p < 0.01). Thirty-four clonorchiasis patients treated with praziquantel 25 mg/kg/day for three days showed a cure rate in 30 days of 97.1%.     

吡喹酮治疗门诊华支睾吸虫病患者的疗效观察

目的 探讨使用吡喹酮治疗门诊华支睾吸虫病患者临床疗效,为门诊常规驱虫治疗提供依据。 方法 选取2018 年 1 月—2020 年 12 月在南宁市武鸣区寄生虫病防治门诊就诊的 2 241 例华支睾吸虫病患者为观察对象,给予吡喹酮总剂量 7 200 mg 分 3 日 9 剂次服用驱虫治疗,同时服用消炎利胆片、护肝片、维生素 B6 等辅助药物,观察并分析治疗效果与不良反应。 结果 治疗后华支睾吸虫病患者粪检虫卵减少率为 100. 00%(2 241 / 2 241),虫卵总阴转率为 98. 93%(2 217 / 2 241),其中轻度、中度、重度感染者阴转率分别为 99.30%(2 124 / 2 139)、91. 92%(91 /99)和 66. 67%(2 / 3),轻度与中度感染者粪检虫卵阴转率差异有统计学意义( χ2 = 50. 660, P= 0. 001)。 粪检虫卵未阴转的患者再次服药治疗后,均未查到华支睾吸虫虫卵。 药物不良反应发生率为 9. 15%,以神经系统症状为主,消化系统次之,症状较轻,未见严重不良反应。 结论 在华支睾吸虫病流行地区医疗卫生机构门诊,使用中剂量吡喹酮抗华支睾吸虫治疗,疗效好,药物不良反应少。     

应用混合单抗双抗体夹心-ELISA法检测肺吸虫循环抗原

用混合单克隆抗体双抗体夹心-ELISA法检测19例痰检虫卵阳性肺吸虫病人,血清中循环抗原全部(100％)皆呈阳性反应。59例根据临床和实验室证据(三项以上免疫学试验呈阳性反应)确诊者,56例(94.9％)显示阳性。在治疗后6个月-3年患者的15例中,14例(93.3％)转为阴性,另一例仍呈阳性反应,因系采用硫双二氯酚治疗未完成疗程者。89名正常人和109例其它7种寄生虫病人,全部皆为阴性,本试验未出现任何假阳性和交叉反应。