阿苯达唑乳剂治疗腹部囊型包虫病B超影像变化的观察

为研究囊型包虫病的包虫囊肿在药物作用下变性坏死各期变化的B超影像特征以及指导临床治疗，经过48例腹部囊型包虫病患服用阿苯达唑乳剂，对各疗程内应用B超动态观察包虫囊变性坏死的影像学变化特征，并拍片存档进行前后结果对照，结果显示两种类型（子囊型和单纯型）包虫囊在治疗过程中有Ⅰ，Ⅱ，Ⅲ，Ⅳ期变性坏死的影像变化，通过B超对包虫囊变性坏死的各期影像变化特征做了观察记录，为临床药物治疗该病并决定疗程长短提供了可靠的依据。     

肝囊型包虫病药物治疗疗效标准的研究

目的 进一步研究和评价囊型包虫病药物治疗的疗效判定标准。方法 采用前瞻性随机对照观察的研究方法，对46例肝囊型包虫病病人进行了研究，其中治疗组31例为经过不同时间阿苯达唑乳剂治疗的病人。对照组18例为未经任何治疗的病人，以外科手术，粗针穿刺抽吸和常规细针穿刺的方法采集包虫囊内容物观察其性状，囊壁组织石腊切片观察组织学变化，收集原头节通过镜下形态及活动的观察，染料排斥试验，犬胆汁激活试验及接种小鼠腹腔6个月后剖检观察有无包虫囊生长的方法判定囊内原头节的死活，结合CT及B超影像特征进行比较评价。结果 治疗组病人中87.1%(21/31)的包虫囊B超影像显示不同程度的退行变性，育囊率为22.6%。对照组病人包虫囊的B超影偈显示退行变性的占11.1%(2/18)，育囊率为61.1%,治疗组判定为痊愈的15例病人的育囊率为13.3%(2/15)。疗效标准与B超影像反映的包虫囊变性死亡的过程一致，与寄生虫学和囊壁组织学变化趋势相符，177例停药后随访1-4年的肝囊型包虫病病人的转归证明了这一标准的可靠性。结论 本研究提出的以B超影偈为基础的肝囊型包虫病药物治疗疗效指标反映了包虫囊在药物作用下从正常生长到变性死亡的过程，是一个比较客观，合理的疗效标准，完全可用于包虫病药物治疗中对疗效的判定。     

肝囊型包虫病药物治疗疗效标准的研究

目的　进一步研究和评价囊型包虫病药物治疗的疗效判定标准。　方法　采用前瞻性随机对照观察的研究方法。对 4 9例肝囊型包虫病病人进行了研究 ,其中治疗组 31例为经过不同时间阿苯达唑乳剂治疗的病人。对照组 18例为未经任何治疗的病人。以外科手术、粗针穿刺抽吸和常规细针穿刺的方法采集包虫囊内容物观察其性状。囊壁组织石腊切片观察组织学变化。收集原头节通过镜下形态及活动的观察、染料排斥试验、犬胆汁激活试验及接种小鼠腹腔 6个月后剖检观察有无包虫囊生长的方法判定囊内原头节的死活。结合 CT及 B超影像特征进行比较评价。　结果　治疗组病人中87.1% (2 1/ 31)的包虫囊 B超影像显示不同程度的退行变性 ,育囊率为 2 2 .6 %。对照组病人包虫囊的 B超影像显示退行变性的占 11.1% (2 / 18) ,育囊率为 6 1.1%。治疗组判定为痊愈的 15例病人的育囊率为 13.3% (2 / 15 )。疗效标准与 B超影像反映的包虫囊变性死亡的过程一致 ,与寄生虫学和囊壁组织学变化趋势相符。177例停药后随访 1～ 4年的肝囊型包虫病病人的转归证明了这一标准的可靠性。　结论　本研究提出的以 B超影像为基础的肝囊型包虫病药物治疗疗效指标反映了包虫囊在药物作用下从正常生长到变性死亡的过程 ,是一个比较客观、合理的疗效标     

超声结合X线摄片在肺囊型包虫病药物治疗中的应用评价

目的将实时超声引用于肺部囊型包虫病的检查并观察包虫囊肿在药物作用下变性坏死程度的影像学特征,以弥补X线摄片诊断的不足.方法每一疗程结束后复查B超和X线摄片(对直径＞4cm未破裂包虫在疗程内只做B超复查),通过不同体位和扫查方法观察肺包虫囊变性坏死程度各期的影像特征并拍照存档.结果应用实时B超检查结合X线摄片,对各疗程内肺部包虫囊变性坏死程度的影像变化特征,均能取得较好的各期可具对比的图像资料.结论实时B超结合X线摄片对临床检查、治疗肺包虫病具有较大的指导价值,可作为临床诊断和药物治疗该病疗效判定的方法应用.     

B超引导穿刺治疗肝囊型包虫病32例

为探讨B超引导穿刺治疗肝囊型包虫病的价值，对32例患者35个包虫囊肿（单囊型27个，多子囊型8个）行B超引导穿刺抽吸囊液后注入20％高渗盐水(其中4例置管引流），并对5个直径大于6cm的囊肿行无水乙醇灭活，一年后25个包虫囊肿（直径2－6cm)完全消失，10个包虫囊肿（直径6－10cm)缩小超过50％，随访1－5年未见复发，B超引导穿刺治疗单囊型及子囊大且少的多子囊型肝包虫病具有疗效肯定，创伤小，费用低的优点。     

经胸手术治疗肝囊型包虫病34例报告

目的肝囊型包虫病突入胸腔者,临床表现和治疗较特殊,本文就临床特点及手术治疗经验进行总结和探讨。方法对1990~2003年收治的经胸手术治疗肝囊型包虫病34例患者进行分析和总结。结果全部病例均经胸或胸腹联合切口手术,并行包虫残腔经腹引流,无死亡病例,均痊愈出院。术后29例随访3年,2例肝包虫复发,经腹肝包虫内囊摘除术随访1~2年无复发。结论术前胸部X线、CT、B超检查,以明确病灶诊断,进胸后先处理肺或膈肌病灶,再探查肝膈面,处理包虫内囊及残腔,置胸腹腔引流。经胸手术治疗肝囊型包虫病需经验丰富的医师参加,术中应仔细,术后应多观察病情变化,及时处理并发症,方可取得满意的治疗效果。     

阿苯达唑乳剂治疗肝囊型包虫病71例临床疗效观察

为观察阿苯达唑乳剂对肝囊型包虫病患的临床疗效，对71例包虫病患用阿苯达唑乳剂按每日每公斤体重12．5mg剂量进行治疗，以B超影像特征判定疗效。连续服药3个月复查一次（1个疗程），各疗程间不停药，停药时的结果为近期疗效，停药后最后一次随访（6个月－2年）的结果为远期疗效，平均近期疗效：有效率89％，治愈率52．1％，无效率为14．1％，平均远期疗效，有效率91．7％，治愈率83．4％，复发率为8．3％，该药比其它抗包虫药物疗效高，不良反应轻，安全可靠，可成为治疗包虫病的首选药物，值得临床推广使用。     

阿苯达唑乳剂治疗肝囊型包虫病212例临床疗效观察

目的　验证新剂型阿苯达唑乳剂对肝囊型包虫病患者的临床疗效。　方法　对 2 12例肝囊型包虫病患者用阿苯达唑 10 m g/ (kg· d)和 12 .5 mg/ (kg· d)两种剂量进行治疗。服药 3个月复查 1次为 1个疗程 ,各疗程之间不间断连续用药。以 B超影像特征为主判定疗效 ,观察不同疗程的效果。以停药时的检查结果为近期疗效。停药后随访 1～ 4年的结果为远期疗效。　结果　两个剂量组共 2 12例患者的平均近期疗效 :治愈率为74.5 % ,有效率为 99.1% ,无效率为 0 .9%。平均远期疗效 :治愈率为 83.1% ,有效率为 89.3% ,无效率为 0 .6 % ,复发率为 10 .2 %。以 12 .5 mg/ (kg· d)连续治疗 9个月的疗效较好。复发病例再治疗的效果良好。　结论　阿苯达唑乳剂对肝囊型包虫病的临床疗效超过当前包虫病药物治疗的最好水平 ,疗效稳定可靠 ,不良反应轻微 ,可成为治疗包虫病的首选药物。     

不同血清学方法对调查现场包虫病人血清的检测及评价

本文应用青海囊型包虫抗原 Dot- EL ISA、IHA和新疆囊型包虫抗原 EL ISA、泡型包虫 EM18抗原 EL IB对流行病学调查现场的 2 0 6例包虫病人血清进行了检测。结果表明青海囊型包虫抗原 Dot- EL ISA和 IHA对囊型包虫病人血清的阳性率分别是 90 .37%和 91.98% ;新疆囊型包虫抗原 EL ISA对囊型包虫病人血清的阳性率为 75 .94% ;三种方法对钙化灶型囊型包虫病人血清的阳性率分别是 77.2 7%、81.82 %和 6 5 .91% ,显著低于其它囊型包虫病人血清的阳性率 ;阴性者主要是单纯性肺脏和肝脏囊型包虫病人血清。3种方法 B超、X线诊断的泡型包虫病人的血清阳性率均为 10 0 .0 %。泡型包虫抗原 EM18-EL IB检测结果表明 ,B超 ,X线诊断的泡型包虫病人血清阳性率为 73.6 8% ;囊型包虫病人血清阳性率为 5 .88% ,其中钙化灶型病人血清阳性率为 15 .91% ;阳性血清数与阴性血清数比例约为 1:7(2 5 :181)。对不同方法在囊型和泡型包虫病诊断与鉴别诊断中的价值及意义进行了讨论     

肝内包虫囊破裂导致的并发症

棘球蚴病又称包虫病,是人兽共患寄生虫病,在人体的多种绦虫病中危害性最为严重。一般多在儿童期感染,到青壮年时期出现症状,并发症可随年龄增长而增加,致使许多青壮年患者丧失劳动力,严重时会威胁生命。本文结合近年来有关肝包虫病的文献,着重阐述肝囊型包虫病包虫囊肿破裂导致的并发症。1 包虫囊肿的病理特征及诱发破裂的因素 肝囊型包虫病的合并症危害严重。单纯性包虫囊肿仅为占位性病变,包虫囊在肝内发展极缓慢,早期临床症状不明显,有些病例肝包虫囊肿巨大但患者的全身健康情况却良好。一旦发生并发症后,临床症状     

Treatment options for hepatic cystic echinococcosis.

A number of surgical and non-surgical options exist to treat cystic echinococcosis of the liver. For decades, surgical excision via a conservative or radical approach was the recommended approach for hepatic hydatid cysts. The availability of chemotherapeutic agents with significant activity against Echinococcus granulosis has made it possible to undertake ultrasound- or computed tomography-guided transhepatic percutaneous drainage (termed puncture, aspiration, injection, and re-aspiration (PAIR)) of hydatid cysts. Pre- and post-intervention chemotherapy with albendazole or mebendazole offers the advantage of reducing the risk of disease recurrence and intraperitoneal seeding of infection that may develop via cyst rupture and spillage occurring spontaneously or during surgery or needle drainage. PAIR appears to have greater clinical efficacy (i.e. a higher incidence of cure), lower rates of major and minor complications, mortality, and disease recurrence, and fewer days of hospitalization compared to patients treated surgically. For patients who fail drug therapy alone, PAIR is a safe and effective procedure of choice for patients with hepatic echinococcosis, and perhaps other anatomic sites of infection such as lung, peritoneum, kidney, and other viscera. Surgery should be reserved for patients with hydatid cysts refractory to PAIR because of secondary bacterial infection or for those with difficult-to-manage cyst-biliary communication or obstruction.     

The clinical and surgical features of right-sided intracardiac masses due to echinococcosis

Right-sided cardiac echinococcosis shows special clinical and surgical features beyond the rareness of echinococcosis in this position, leading to serious and life-threatening complications. We examined our cardiac hydatid cyst patients, retrospectively, and report our experience of the surgical treatment of right-sided cardiac hydatid cysts. Between 1985 and 2000, seven patients were transferred to our department from the cardiology department with a diagnosis of cystic cardiac masses which were highly suspected of being hydatid cysts. Two were males and 5 were females. In 3 patients the hydatid cyst was located in the right ventricle, and one was in the right atrium. The mean age of the patients was 37 years (ranging from 12 to 60 years). One patient had preoperative pulmonary emboli. In all right-sided cardiac echinococcosis patients, cardiopulmonary bypass was used. All cysts were cleaned after quilting the cystic cavities, and daughter cysts were removed carefully. The cavities were closed with purse-string sutures. Postoperatively, one patient had pulmonary emboli. In all patients, mebendazole was administered postoperatively. When a right-sided cardiac hydatid cyst is diagnosed, early surgical treatment should be performed under open-heart surgery conditions. During the operation, a single cannula in the superior vena cava should be used until fibrillation, and after clamping, the cannula for the pulmonary artery inferior vena cava should be inserted.     

International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings

The increased knowledge of the natural history of cystic echinococcosis (CE) by the recent expansion in the use of ultrasound (US) in field and clinical studies has necessitated the development of a new WHO standardised classification of US images. Use of such a classification will enable clinicians to examine recommended clinical procedures for the different cyst types. It will also allow scientists to compare data on the occurrence of cyst types in different parts of the world providing evidence to examine strain differences in the causative organism Echinococcus granulosus. The classification proposed follows that of the first classification developed by Gharbi et al. [Radiology 139 (1981) 459] which has been widely used, but in modified forms, since its publication. The classification presented here is intended for use in field epidemiological studies as well as for clinical investigators. The classification is intended to follow the natural history of CE and starts with undifferentiated simple cysts, as presumably hydatid cysts evolve from these structures. These simple cysts, however, may be due to a number of different aetiologies (parasitic lesions, congenital disorders, biliary cysts or neoplasms) and, therefore, require further diagnostic tests to reveal their identity. As their origin is uncertain they are not given the designation of a CE type lesion, and, in the proposed classification, should be recorded as cystic lesions (CL). The first clinical group starts with cyst types CE 1 and 2 and such cysts are active, usually fertile cysts containing viable protoscoleces. CE Type 3 are cysts entering a transitional stage where the integrity of the cyst has been compromised either by the host or by chemotherapy and this transitional stage is assigned to the second clinical group. The third clinical group comprises CE Types 4 and 5 which are inactive cysts which have normally lost their fertility and are degenerative. The use of the standardised US classification will facilitate the application of uniform standards and principles of treatment currently recommended for each cyst type.     

Pulmonary echinococcosis.

Echinococcosis or hydatid disease is caused by larvae of the tapeworm Echinococcus. Four species are recognised and the vast majority of infestations in humans are caused by E. granulosus. E. granulosus causes cystic echinococcosis, which has a worldwide distribution. Humans are exposed less frequently to E. multilocularis, which causes alveolar echinococcosis. E. vogeli and E. oligarthrus are rare species and cause polycystic echinococcosis. In cystic echinococcosis, humans are an accidental host and are usually infected by handling an infected dog. The liver and lungs are the most frequently involved organs. Pulmonary disease appears to be more common in younger individuals. Although most patients are asymptomatic, some may occasionally expectorate the contents of the cyst or develop symptoms related to compression of the surrounding structures. Other symptoms of hydatid disease can result from the release of antigenic material and secondary immunological reactions that develop from cyst rupture. The cysts are characteristically seen as solitary or multiple circumscribed or oval masses on imaging. Detection of antibody directed against specific echinococcal antigens is found in only approximately half of patients with pulmonary cysts. Surgical excision of the cyst is the treatment of choice whenever feasible.     

肝包虫病超声影像学特征观察

目的了解包虫病的超声影像学特征。方法对四川省石渠县人群进行包虫病B超检查和血清学检查以确诊病人,利用WHO-IWGE提出的分型标准和卫生部包虫病诊断标准进行分析。结果检查出了187名包虫病病人,两型包虫病的各型均有发现,并对其进行了分型,观察和描述各型病灶超声影像学表现,并对各型病灶所在肝脏位置进行了统计。     

Praziquantel: Neglected drug? Ineffective treatment? Or therapeutic choice in cystic hydatid disease?

The role of praziquantel in hydatid disease has not been well defined. This review evaluates the evidence on the use of praziquantel in treatment of cystic hydatid disease from in vitro and in vivo animal studies, human clinical studies and case reports. Praziquantel may prevent the vesicular evolution of protoscoleces and inhibit the formation of secondary cysts. It may also contribute to the loss of viability of small cysts before cyst differentiation and development of the fibrous adventitial layer. There is some evidence to support a role for the use of praziquantel in combination with albendazole in pre- and post-intervention chemotherapy for hydatid disease. Combined therapy may reduce the risk of disease recurrence and intraperitoneal seeding of infection that develops via cyst rupture and spillage occurring spontaneously or during surgery or percutaneous procedures. At present, there is insufficient published evidence to support a clear recommendation for the use of praziquantel in prolonged chemotherapy for established hydatid disease for which surgery is not indicated or in severe disseminated disease and further work is necessary. Randomised controlled studies to determine the efficacy and optimum duration of praziquantel treatment in combination with albendazole are required so that treatment recommendations for its use can finally be clarified.     

Two-dimensional echocardiographic features of echinococcosis of the heart and great blood vessels. Clinical and surgical implications

Echocardiographic findings in cardiac echinococcosis have been previously described in isolated cases, but no detailed account of the various echocardiographic aspects and their clinical and surgical implications have ever been reported. We present a retrospective analysis of the two-dimensional echocardiograms of 15 patients with hydatid cysts affecting the heart or great blood vessels. Two-dimensional echocardiogram features were compared with the main clinical syndromes. Surgical confirmation of the echocardiogram findings was available in 12 patients. The cyst sizes ranged from 0.5 to 12 cm in diameter. Eleven patients had single cysts, three patients had two cysts, and one patient had multiple cysts. Cysts were located in the intramyocardial region in nine patients, the pericardial in three, and the paracardial in another three. All intramyocardial cysts protruded into the adjacent cardiac chamber, but in only two patients was there significant tricuspid valvular dysfunction. Pericardial and mediastinal cysts showed compression of cardiac chambers or great blood vessels, and two cysts had ruptured into the descendent thoracic aorta or inferior vena cava. In most patients, two-dimensional echocardiographic images of hydatid cysts were those of a cystic mass having well-defined edges and internal trabeculations corresponding to daughter membranes. However, in four patients, two-dimensional echocardiographic images showed a "solid" mass instead of a cystic mass, and in one patient with the multivesicular variety of echinococcosis, the images showed a large mass with poorly defined edges having a honeycombed appearance causing lysis of the anterior arch of the second and third left ribs. The two-dimensional echocardiographic finding showed good correlation with main clinical syndromes, but anaphylactic reactions occurred in every cyst location. In one patient, postoperative two-dimensional echocardiography showed two small intramyocardial cysts that had not been noticed during preoperative two-dimensional echocardiography or during surgical examination. Pathological examination in the four patients with a solid mass showed replacement of the hydatid liquid by necrotic matter containing membrane residues with a foreign-body inflammatory reaction of a granulomatous type. In conclusion, two-dimensional echocardiography is a very useful tool for diagnosis and management of patients with cardiac echinococcosis, but the great diversity of findings regarding number, size, location, and appearance of cysts must be borne in mind to interpret correctly the two-dimensional echocardiograms.     

Improved experimental model of hepatic cystic hydatid disease resembling natural infection route with stable growing dynamics and immune reaction

AIM To investigate a safer way to set up the disease model of cystic echinococcosis without contamination risk and develop a novel experimental murine model of hepatic cystic echinococcosis. METHODS C57 B/6 mice were injected with human protoscolices of three different concentrations via the portal vein. The mice were followed for 10 mo by ultrasound,gross anatomy,and pathological and immunological examinations. The protoscolex migration in the portal vein,hydatid cyst growth,host immune reaction,and hepatic histopathology were examined periodically.RESULTS The infection rates in the mice in the high,medium,and low concentration groups were 90%,100%,and 63.6%,respectively. The protoscolices migrated in the portal vein with blood flow,settled in the liver,and developed into orthotopic hepatic hydatid cysts,resembling the natural infection route and course.CONCLUSION We have established an improved experimental model of hepatic cystic echinococcosis with low biohazard risk but stable growing dynamics and immune reaction. It is especially useful for new anti-parasite medication trials against hydatid disease.