盆腔细粒棘球蚴病的诊断及治疗

目的 探讨盆腔细粒棘球蚴病的诊治方法.方法 对1980年1月至2009年1月收治的16例盆腔棘球蚴病病例的资料进行分析.结果 16例患者均有疫区犬、羊接触史,以下腹部包块为主要临床表现.用棘球蚴病囊液抗原(EgCF)、头节抗原(EgP)、囊液半纯化抗原B(EgB)、泡球蚴抗原(Em 2)等4项免疫试验检查4例,3例阳性.超声波和CT诊断符合率分别为35.7%和55.6%.采用内囊摘除术或外囊完整摘除术为主的手术治疗.16例中8例术前诊断明确.2例术前外伤破裂、1例术中囊液外溢共3例出现过敏性休克,经手术、抗过敏、抗感染治疗后治愈.4例术后复发.结论 流行病学、免疫学、CT及超声波检查是诊断盆腔棘球蚴病的主要方法.膀胱部分切除或内囊摘除术是治疗的主要手段.     

3例手术和病理证实的肾棘球蚴病回顾性分析

对3例经手术、病理证实的肾棘球蚴病病例进行回顾性分析。3例均行64排CT平扫和多期增强扫描, 其中多子囊型肾棘球蚴病2例,单纯囊肿型肾棘球蚴病1例。1例术前作出正确诊断,另2例分别被误诊为肾囊肿及肾错构瘤。通过观察肾棘球蚴病的CT征象并结合患者病史能提高对肾棘球蚴病诊断的准确性。     

肝棘球蚴病穿刺治疗中过敏性休克的防治

肝棘球蚴病穿刺治疗中的过敏性休克是穿刺治疗长期列为禁忌的重要原因之一 。但随着治疗病例的增多 ,过敏性休克实际发生率较低 ,穿刺治疗已被广泛接受 。由于肝棘球蚴囊肿穿刺中过敏性休克的发生率较低而对其预防易被忽视 ,一旦出现过敏性休克后病情十分危险。为探讨其发生的原因 ,减少其发生 ,以及在其发生后得到及时正确治疗 ,作者将1998～2002年穿刺治疗中出现过敏性休克的5例棘球蚴病患者进行回顾性调查分析 ,报道如下。     

原发性脾棘球蚴病1例报道

棘球蚴病由细粒棘球绦虫或多房棘球绦虫引起。人是其中间宿主。当误食虫卵后，六钩蚴经肠壁随血循环侵入组织，主要是肺和肝。孤立的原发性脾棘球蚴病很罕见。继发性的脾棘球蚴病主要是自发的或者手术引起的肝棘球蚴囊的破裂导致原头节向脾播散。这里介绍第一例用超声介导的细针诊断技术诊断的原发性脾棘球蚴病。     

复杂性肝棘球蚴病外科治疗策略研究进展

肝棘球蚴病是一种由棘球属绦虫幼虫所致的人畜共患性疾病。我国主要致病绦虫类型为细粒棘球绦虫和多房棘球绦虫,分别引起细粒棘球蚴病和多房棘球蚴病。目前,棘球蚴病治疗已经取得重大进展,但对于部分就诊时已出现一种或多种并发症以及病灶侵及肝门、重要血管及胆管的复杂性棘球蚴病病例的治疗仍存在一定困难。本文根据近年来文献报道,结合临床经验,对复杂性肝棘球蚴病的外科治疗策略进行综述。［关键词］     

198例肺棘球蚴病的外科治疗效果分析

目的总结肺棘球蚴病的外科治疗经验,选择合适的手术方式避免手术后复发。方法回顾性分析新疆医科大学第一附属医院2000年1月～2010年10月手术治疗的198例肺棘球蚴病患者的临床资料,包括一般情况、病程、流行病学、临床表现、治疗和转归情况等。结果 198例肺棘球蚴病患者中,男性114例,女性84例,年龄2～68岁,平均25.5岁。绝大多数为农牧民(148例,74.7%)和未成年人(43例,21.7%)。手术方法以内囊完整摘除术和内囊穿刺摘除术为主。198例患者无手术死亡,均痊愈或好转出院,术后并发肺部感染9例(4.5%),切口裂开7例(3.5%),切口感染4例(2.0%),均经局部换药延期愈合,术后随访1～10年,随访率为83.3%(165/198),随访期间11例复发,复发率5.6%(11/198)。198例患者共行226次手术,复发病例均经手术治愈。结论内囊摘除术是治疗肺棘球蚴病常用手术方式,手术效果好,术后复发率低。     

肾棘球蚴病8例

棘球蚴病是牧区常见的地方病。人是中间宿主 ,如果误食犬细粒棘球绦虫卵 ,即在十二指肠孵化成六钩蚴 ,穿过肠黏膜潜入门静脉 ,寄生于肝脏。六钩蚴也可穿过门静脉 ,寄生于肺脏。人的棘球蚴病多发于肝、肺 ,仅有极少量的六钩蚴随动脉血流进入全身其他脏器 。新疆伊犁州新华医院1987～2002年 ,共治疗棘球蚴病524例 ,其中肾棘球蚴病8例 ,报告如下。     

复杂肝包虫手术及残腔处理方法探讨

肝泡状棘球蚴病（Hepatic alveolar echinococcosis,AE）系泡状棘球绦虫所致。分为肝棘球蚴病和肝泡球蚴病,吐鲁番地区是人体肝包虫病的多发区,对本区人民健康造成严重危害。目前对复杂肝包虫手术及残腔处理临床上仍比较棘手。现就我院1998至2009年收治的213例复杂肝包虫病患者治疗情况报道如下。     

手术治疗肝包虫病的临床体会

肝包虫病(肝棘球蚴病)是西北地区分布较广的常见寄生虫病，是细粒棘球绦虫幼虫侵入人体肝脏所致。对人体危害极大。本文总结我院近年来收治的23例肝包虫病病例资料，讨论其手术治疗效果。     

2000～2002年新疆塔城市、额敏县中小学生包虫病B超筛查报告

包虫病是棘球绦虫的幼虫寄生于人及某些动物等中间宿主所致慢性寄生虫病,我区包虫病有囊性包虫病(CHD)和泡球蚴病(CAHD).囊性包虫病可以发生在人体的各个部位,如:肝、脾、腹腔、双肾,肺、脑、骨等.由多房棘球蚴绦虫感染所致的泡球蚴病90%以上发生于肝脏.为了解塔城市和额敏县的棘球蚴病在学生中流行状况并为今后的防治工作提供科学依据,我们于2000～2002年对塔城市、额敏县城镇和农村中小学生,采用B超腹部扫描进行了包虫病检查,现将结果报告如下.     

Case Report: Immunological Characteristics of Recurrent Echinococcosis-Induced Anaphylactic Shock

Anaphylactic shock represents a serious complication of echinococcosis as up to 4.6% of patients die as a result of its severity and improper handling. Once a definite diagnosis is made, effective treatments need to be immediately initiated. Here, we report the immunological characteristics and management of two patients with recurrent anaphylactic shock concurrent with the surgical removal of hydatid cysts. Both patients had systemic echinococcosis classified as cystic echinococcosis type 2 (CE2) with multiple, immature cysts (absence of calcification and necrosis). In addition, both patients had increased eosinophils and basophils before surgery, as well as elevated crude hydatid cyst fluid antigen (anti-EgCF) and hydatid cyst fluid native antigen B (anti-EgB) antibodies and high IgG levels. Although we cannot definitively predict which patients are at risk for cyst fluid leakage or anaphylactic shock at present, clinicians may consider taking precautions before surgery on encountering patients with a similar profile to prevent the occurrence of anaphylactic shock and the likelihood of a second incident. However, these observations need to be confirmed in further studies with a larger number of patients.     

Acute intraperitoneal rupture of hydatid cysts of the liver: Case series

Hydatid cyst is a parasitic infection caused mainly by Echinococcus granulosus, which is generally considered benign. However, the hepatic hydatid cyst rupture in the abdominal cavity is a life-threatening incident that requires urgent and multidisciplinary management (emergency physicians, radiologists, anesthetists, and surgeons). This study describes clinical and paraclinical liver hydatid cyst rupture in the peritoneal cavity and details the appropriate treatment.A retrospective review of clinical records of patients hospitalized in Jendouba Hospital for liver hydatid cyst was performed over 8 years, from January 1, 2012 to December 31, 2019. Fifteen cases of liver hydatid cyst complicated with acute rupture into the abdominal cavity were collected out of 625 hydatid liver cysts. All patients underwent emergency laparotomy allowing conservative unroofing procedure associated with peritoneal lavage and external drainage combined with necessary intensive care measures. Clinical features, therapeutic procedures’ details as well as postoperative outcomes are reported. Statistical analysis was performed using the Statistical Package for the Social Sciences for Windows version 20.There were 9 men and 6 women. Patients’ age ranged from 14 to 59 years, with an average of 38 years. Two patients were admitted with abdominal trauma. Acute abdominal pain was the most common complaint. Only 1 patient had an anaphylactic shock. Abdominal ultrasonography and computed tomography scan showed discontinuous cyst wall associated to intraperitoneal fluid in all cases. Intraoperatively, the intraperitoneal effusion was clear in 13 cases and purulent in 2. All patients underwent unroofing procedures associated with intra-operative peritoneal lavage and external drainage. The mean hospital stay was 6.11 days, and the mean follow-up was 19 months. No case of recurrence was reported among the patients.In endemic areas, rupture of a hepatic hydatid cyst in the abdominal cavity should be considered in every case of acute abdominal pain, especially if associated with anaphylaxis signs. Early management starting in the emergency room is needed to ensure good outcome.     

肝包虫病1314例的临床分析

本文报道近40年期间经手术治疗肝包虫病1 314 例的临床分析及诊断方法的发展。本病多发于青少年,包虫生长缓慢,早期无明显症状。在70年代以前主要以触诊包虫囊肿的特殊体征与皮内试验为诊断方法,因之早期诊断率较低,甚至发生并发症有时仍被误诊,本组并发感染占20.2％,并发破裂9.9％,合并门静脉高压症2.4％,并发过敏性休克 1.9％,皆引起严重后果。随着诊断仪器的发展,应用超声波探查、核素扫描、X线特殊造影、CT 扫描及免疫试验等方法,不仅可发现无症状的带虫者,提高早期诊断率达 100％,并可检测出包虫囊肿的病理形态及各类并发症的病理改变,从而施行早期手术及优选最佳手术方案,提高治愈率。     

老年过敏性休克人体组织中嗜酸粒细胞趋化因子表达的研究

目的探讨过敏性休克法医学客观诊断标准。方法对过敏性休克死者,肺、肾、肠、喉组织进行嗜酸粒细胞趋化因子(Eotaxin)mR-NA原位杂交。结果过敏性休克死者肺、肾、肠、喉组织Eotaxin mRNA原位杂交表达与对照组相比有显著性差异。结论过敏性休克时Eotaxin mRNA可作为法医检案客观诊断标准。     

Pregnancy and hydatid cyst

Cyst hydatid disease (CHD) can be localized in every organ and frequently seen in Turkey. Twenty weeks pregnant woman was admitted with hemoptysis and dyspnea. Chest X-ray revealed bilateral homogeneous dansities. We planned to end pregnancy or follow until term, as diagnosis of CHD. The patient refused delivery. Eleven months later she was admitted with haemoptysis and syncope. Chest X-ray showed cavitary lesion, pleural effusion, pneumothorax in right lung and another cavitary lesion in left. Tube thoracostomy performed with the diagnosis of perforated cyst hydatid (CH) and the patient operated. CH may enlarge in pregnancy. Cyst rupture can cause anaphylactic shock and hemoptysis. Pregnancy and CHD occur occasionally together and there is no consensus about treatment.     

Pulmonary embolism and anaphylactic shock caused by rupture of a hepatic hydatid cyst

A 44 year old man was admitted to hospital as an emergency for shock associated with giant urticaria and atrial fibrillation. Angiography showed pulmonary embolism, and an image suggesting a hydatid cyst of the liver was observed by echocardiography in the sub-costal view, confirmed by liver ultrasonic scan and serology. After treatment with Albendazole, the cyst was removed surgically and histology showed the characteristic appearances of hydatid disease. The final diagnosis was rupture of a hydatid cyst into a sub-hepatic vein with anaphylactic shock and pulmonary embolism.     

Management of intrabiliary ruptured hydatid disease of the liver

BACKGROUND/AIMS: Intrabiliary rupture of hydatid cyst is an important complication of hydatid disease of the liver. The purpose of this study was to evaluate outcomes of patients with intrabiliary ruptured hydatid disease of the liver. METHODOLOGY: Two hundred and eleven patients were operated upon for hydatid cyst of the liver between 1990 and 1998 in our hospital. Twenty-four patients with intrabiliary rupture of hepatic hydatid cyst were retrospectively reviewed. RESULTS: Diagnosis of hydatid cyst was principally made using ultrasonography. We performed partial cystectomy + omentoplasty + transduodenal sphincteroplasty for 18 patients (75%). Daughter cysts and hydatid debris were found in common bile duct in 8 patients (33%). Internal opening of biliary fistula was found in 21 patients (87.5%). Morbidity rate was 12%. One patient died of unrelated causes. The average postoperative hospitalization period for the sphincteroplasty group was 7.6 days. CONCLUSIONS: Preoperative radiologic examination and laboratory values were not helpful to exclude an intrabiliary rupture of hydatid cysts in our patients. If bile stained cystic fluid is found, it is clear that a communication between hydatid cysts and the biliary tree exist. Transduodenal sphincteroplasty can be preferred in the management of intrabiliary ruptured hydatid disease because of short hospitalization, low morbidity, and ability to decompress intrabiliary pressure.     

Fifteen year surveillance of echinococcal heart disease from a referral hospital in Greece

Ten cases of hydatid heart disease were treated over a 15-yearperiod (1980–1995). Cysts were located in the left ventricularwall (four patients), right ventricular wall (one patient),interventricular septum (one patient), interatnal septum (onepatient), right atrium (one patient), pericardial cavity (onepatient) and in multiple loci (one patient). Apart from twoasymptomatic cases, clinical manifestations included chest pain(four patients), anaphylactic shock (one patient), constrictivepericarditis (one patient), congestive heart failure (one patient)and arterial embolism (one patient). Computed tomography wasfound useful in the detection of hydatid cysts and also in thedetermination of their morphology. Magnetic resonance was performedin three patients, with satisfactory imaging. Three out of the10 patients died: rupture of pulmonary echinococcal cyst (onepatient), massive pulmonary hydatid embolism (one patient) andrupture of an undiagnosed hydatid cyst of the right atrium duringcannulation for cardiopulmonary bypass (one patient). One otherpatient experienced recurrent systemic embolism and became hemiplegic.Six patients were successfully treated. In five patients, thecysts were excised by open heart surgery, while in one by pericardiectomy.In addition, antiparasitic drugs were successfully used in twopatients with long-term satisfactory results. In conclusion, cardiac echinococcosis is associated with anincreased risk of potentially lethal complications. Newer techniquesof cardiac imaging have helped locate the cysts while surgicalremoval may offer cure. Some patients responded to specificlong-term drug treatment.     

Ruptured hydatid cyst in a patient with shock

Echinococcosis is a severe helminthic zoonosis largely caused by Echinococcus granulosus and frequently encountered in endemic areas.The liver and lung are the most frequently involved organs.Cyst rupture into the peritoneal cavity represents a rare but serious complication.Herein,we describe an acute occurrence of anaphylactic shock due to a spontaneous rupture of hydatid cyst in a 21-year-old Turkish patient unwittingly infected by Echinococcosis.Resection surgery of the perforated cyst in combination wit...     

Intracavitary left ventricular hydatid cysts ruptured during cardiopulmonary resuscitation in a patient with acute myocardial infarction

Cardiac hydatid cyst is a rare complication of parasitic infection caused by Echinococcus granulosus. Cardiac involvement occurs in only 0.2-2% of hydatidosis cases. Rupture of hydatid cysts into cardiac chambers is very rare. In this report, we present a case of intracavitary left ventricular hydatid cysts ruptured during cardiopulmonary resuscitation in a patient with acute myocardial infarction.