百克钳在肝包虫外囊完整剥除术中的临床应用

目的：探讨百克钳应用于肝包虫外囊完整剥除术中的可行性、有效性和安全性。方法选择2006年7月-2013年7月行百克钳肝包虫外囊完整剥除术（百克钳组）21例和行常规器械肝包虫外囊完整剥除术（常规器械组）32例患者,观察两组术中情况、术后疗效及并发症发生情况。结果53例患者均顺利完成手术。两组患者术中出血量、术后平均住院时间及术后并发症胆漏、术区积液与胸腔积液差异均无统计学意义（P ＞0．05）,而手术时间比较差异有统计学意义（P ＜0．05）。结论百克钳应用于肝包虫外囊完整剥除术安全、有效,并可缩短手术时间,值得临床推广。     

肝包虫外囊完整剥除术临床应用体会

肝囊性包虫病是牧区常见寄生虫病,首选治疗方法是手术切除。传统的手术方式以内囊摘除术为主,但术后胆漏、残腔感染等并发症发生率较高（10．8％-65．8％）,且复发率高（4．5％-20．2％）。近期临床研究中发现,肝包虫外囊与肝组织间存在一层纤维组织膜,即外膜。外膜与外囊间存在可分离间隙,沿此间隙可完整剥除肝包虫外囊,此术式称为肝包虫外囊完整剥除术。     

肝包虫外囊完整剥除术治疗肝包虫病41例分析

目的探讨肝包虫外囊完整剥除术治疗肝包虫病的临床特点及其疗效.方法分析2009年5月~2011年12月我院采用肝包虫外囊完整剥除术治疗41例肝包虫病患者的临床资料.结果41例均获临床治愈,术后2例切口感染,经抗感染、换药后治愈,无胆漏、残腔感染等并发症.随访38例,随访时间1~2年均无复发病例,随访率92.68%.结论肝包虫外囊完整剥除术可作为治疗肝包虫病的首选治疗方法,具有操纵简单、损伤轻、出血少的优点,避免术后胆漏、残腔感染、复发的难题.     

40例肝包虫外囊完整剥除术的临床分析

目的总结肝包虫外囊完整剥除术的临床体会。方法采用肝包虫外囊完整剥除的术式。结果40例肝包虫病,均取得了较好疗效。术后随访病例37例,时间6-18个月,无任何并发症。结论肝包虫外囊完整摘除术可以防止术中囊液外漏、残腔形成及术后复发,达到了根治肝包虫病的目的。     

治疗肝包虫病的新术式——肝包虫外囊剥除术的探讨

目的探讨一种新术式——肝包虫外囊剥除术治疗肝包虫病的疗效。方法住院肝包虫病患者12例，经影像学定位并结合术中病灶位置，采用肝包虫外囊剥除术治疗。结果临床疗效满意，术后无胆瘘、出血、感染等并发症，平均手术后9d治愈出院。结论肝包虫外囊剥除术治疗肝包虫病是一种合理而可行的术式，可一次性完整剥除病灶，减少并发症，降低费用，提高病人的生活质量，具有良好的临床应用价值，值得探讨。     

肝包虫外囊完整剥除术治疗肝包虫病36例体会

目的 探讨肝包虫外囊完整剥除术治疗肝包虫病的疗效.方法 回顾性分析2006年1月~2010年1月精河县人民医院应用外囊完整剥除术治疗36例肝包虫病的临床资料.结果 36例均获临床治愈,术后无胆漏、残腔感染等并发症,随访16~24个月无复发.结论 肝包虫外囊完整剥除术是一种安全可行的术式,解决了传统的内囊摘除术后胆漏、残腔感染、复发的问题,应作为肝包虫囊肿治疗的首选术式.     

11例肝包虫外囊剥除术临床初步观察

目的：探讨肝包虫外囊剥除术治疗肝包虫病的疗效。方珐：采用肝包虫外囊剥除术治疗11例肝包虫病患者。结果：全组病人术后恢复良好，无胆瘘、出血、感染等并发症。结论：肝包虫外囊剥除术治疗肝包虫病是一种合理而可行的新术式，可解决以往传统的内囊摘除术由于囊液外溢导致的复发问题，远期临床疗效尚需积累更多的病例和进行更长期的随访以进一步观察。     

外囊完整剥除与内囊摘除治疗肝囊型包虫病的体会

目的：总结肝囊型包虫病462例手术治疗的经验。方法：对2003～2013年收治的462例肝囊型包虫病患者的临床资料进行回顾性分析。结果：其中147例行包虫外膜内外囊切除的根治性手术,315例行内囊摘除、外囊内翻缝合或大网膜填塞缝合囊腔关闭术,所有病例均临床治愈,无死亡病例。结论：外科手术是肝囊型包虫病的主要治疗方法,根据包虫大小、发生部位、数目及医生的经验采用包虫外囊完整摘除的根治性手术,内囊摘除、外囊内翻缝合或大网膜填塞缝合囊腔关闭术等均为治疗肝囊型包虫病的有效方法。     

新术式肝包虫外囊剥除术的配合体会

肝细粒棘球蚴病为新疆的常见病、多发病，传统的手术方法为肝包虫内囊摘除术，但术中存在着复发、残腔感染以及胆瘘等问题，我院于2002年6月-2003年8月采用新术式肝包虫外囊剥除术治疗了11例肝包虫病患者，手术效果显著，现将手术配合体会报告如下。     

68例肝包虫囊肿外囊完整摘除术的护理

肝棘球蚴病（hepatic echinococcosis）又称肝包虫病（hepatic hydatidosis）是流行于世界畜牧业发达地区常见的人畜共患性寄生虫病。宁夏回族自治区是肝泡型包虫病（hepatic alveolar echinococcosis，HAE）的高发区，主要分布在南部山区西吉县各乡镇。本文就西吉县人民医院2001～2003年对68例肝包虫囊肿外囊完整摘除术患者的护理体会总结如下。     

经皮细针穿刺治疗肝囊型包虫病22例初步临床观察

１９９６年１月至１１月期间,我科依照ＷＨＯ有关人体包虫病治疗指导纲要推荐的穿刺治疗包虫病方法（简称ＰＡＩＲ）,在麻醉科医师监护下,由Ｂ超定位引导细针（内径０．６～１．３ｍｍ）穿刺治疗了２２例肝囊型包虫病患者共计２６个包虫囊。经过７～１８个月的临床随访,结果：（１）包虫囊消失或小于１ｃｍ者占３１％,囊包虫缩小６５％以上者３１％包虫囊缩少４０％～５０％者占３８％;（２）其中５例患者置管外引流２周至３个月不等,拔管后情况良好。４例穿刺证实为包虫术后残腔。穿刺治疗前后所有患者均给予口服丙硫咪唑（ａｌｂｅｎｄａｚｏｌｅ）,每日每公斤体重１０～１５ｍｇ。穿刺前用药３～５ｄ,穿刺后酌情用药１～３个月,每３个月进行Ｂ超随访至少２年。初步结果表明：在严格掌握穿刺适应证条件下,ＰＡＩＲ可作为一种经济、有效、创伤小的治疗手段,尤其对有多次手术史的肝包虫病患者更具优越性。     

Continuous long-term albendazole therapy in intraabdominal cystic echinococcosis

Ａｌｂｅｎｄａｚｏｌｅｈａｓｂｅｅｎｗｉｄｅｌｙｕｓｅｄｉｎｔｈｅｔｒｅａｔｍｅｎｔｏｆｃｙｓｔｉｃｅｃｈｉｎｏｃｏｃｃｏｓｉｓ ,ｂｕｔｒｅｌａｔｉｖｅｌｙｆｅｗｌｏｎｇ ｔｅｒｍｆｏｌｌｏｗ ｕｐｒｅｓｕｌｔｓａｒｅａｖａｉｌａｂｌｅｔｏｅｖａｌｕａｔｅｌｏｎｇ ｔｅｒｍｅｆｆｉｃａｃｙａｎｄｓａｆｅｔｙ Ｉｎｔｈｉｓｓｔｕｄｙ ,ｗｅｆｏｌｌｏｗｅｄｕｐ 15ｐａｔｉｅｎｔｓｗｈｏｒｅｃｅｉｖｅｄｃｏｎｔｉｎｕｏｕｓｌｏｎｇ ｔｅｒｍａｌｂｅｎｄａｚｏｌｅｔｈｅｒａｐｙ ;ｃｌｉｎｉｃａｌｔｈｅｒａｐｅ…     

Community survey, treatment and long-term follow-up for human cystic echinococcosis in northwest China

Background  Human cystic echinococcosis (CE) is a parasitic zoonosis of major public health importance throughout the world. CE is endemic throughout central Asia including northwestern China. In China, CE has been reported in 21 provinces, autonomous regions and municipalities, covering approximately 87% of China’s territories. It is most common in the pastoral and semi-pastoral western provinces and regions. This study aimed to reveal the natural history, curative effect and possible re-infection risk factors of human CE through long termed follow-up of treated and untreated CE cases in Hobukesar, Xingjiang, China.

Methods  Follow-up studies on CE were performed twice in Hobukesar from August 2005 to October 2008, after an initial mass screening performed in 1995 and 1996. Ultrasound scan was the primary diagnostic method.

Results  Among 24 patients with confirmed CE, 22 were treated (surgery in 19 and chemotherapy in three). Two recurrent cases and one re-infection case were subsequently found during follow-up. The CE type of one of the recurrent cases reverted from CE4 to CE3, as classified using World Health Organization (WHO) guidelines.

Conclusions  Ultrasound was required to differentiate primary, recurrent and re-infection cases during epidemiological investigation and follow-up of CE. Most patients did not change their habits, which may be one possible cause of reinfection. One recurrent case suggested that, despite initial suggestion from the WHO Informal Working Group on Echinococcosis, CE4-type cysts are not inactive.

     

中国西北部囊型包虫病流行病学调查后的长期随访研究

Background Human cystic echinococcosis (CE) is a parasitic zoonosis of major public health importance throughout the world. CE is endemic throughout central Asia including north-western China. In China CE has been recorded in 21 of China's 33 provinces, autonomous regions and municipalities, covering approximately 87% of China's territories. The highest prevalence occurs in the pastoral and semi-pastoral western provinces and regions. This study aimed to reveal the natural history, curative effect and possible re-infection risk factors of human cystic echinococcosis (CE) through long–term follow-up of treated and untreated CE cases in Hobukesar, Xingjiang, Northwest China. Methods Follow-up studies about CE were carried out twice in Hobukesar from August 2005 to October 2008. Ultrasound scan was primary diagnostic method. Results Among 24 patients confirmed CE, 22 patients were treated (including surgery in 19 cases and chemotherapy in 3 cases). Two recurrent cases and one re-infective case were found during the studies. The type (WHO classification) of one of the recurrent cases transformed from CE4 to CE3. Conclusions Ultrasound was required to differentiate primary, recurrent and re-infective cases during epidemiological investigation and follow-up of CE. Most patients did not change their habits was one of the possible causes of re-infection. One recurrent case suggested that biological status of CE4 was not inactive prompted by World Health Organization.     

Clinical efficacy of albendazole emulsion in treatment of 212 cases of liver cystic hydatidosis

目的：验证新剂型阿苯达唑乳剂对肝囊型包虫病患的临床疗效。方法：对２１２例肝囊型包虫病患用阿苯达唑10mg/Kg/d和12.5mg/Kg/d两种剂量进行治疗。服药3个月复查一次为一个疗程,各疗程之间不断连续用药。以B超影象特征为主判定疗效。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212例患的平均近期疗效为：治愈率74.5％,有效率为99.1%,无效率为0.9%。平均远期疗效为：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12.5mg/Kg/d连续治疗9个月的疗效最好。复发病人再治疗的效果良好。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。且疗效稳定可靠,不良反应轻微。可做为包虫病首选治疗方法。     

肝囊型包虫病合并肺囊型包虫病41例诊疗分析

目的：探讨一期和分期手术治疗对肝囊型包虫病合并肺囊型包虫病患者预后的影响。方法：将1999年1月至2013年1月在新疆医科大学第一附属医院进行手术治疗的41例患者根据手术方式分为A组（一期手术组,21例）和B组（分期手术组,20例）,并对手术方式及预后进行探讨。结果：两组患者全治愈。A组复发4例,B组复发3例。结论：在肺包虫囊肿合并肝包虫囊肿的处理当中,充分认识术前病情,严格掌握两种手术路径的适应证,严格操作,可以获得满意的治疗效果。     

A molecular survey on cystic echinococcosis in Sinnar area, Blue Nile state (Sudan)

Background  Cystic echinococcosis (CE) is a zoonosis caused by the cestodes of the Echinococcus species. Its life cycle involves dogs and other canids as definitive hosts for the intestinal tapeworm, as well as domestic and wild ungulates as intermediate hosts for the tissue-invading metacestode (larval) stage. The disease has a special impact on disadvantaged pastoralist communities and is listed now among the three top priority neglected tropical disease (NTD). Therefore, CE is a neglected disease even in high endemicity regions. This study aimed at investigation of the prevalence of CE in different animals slaughtered for food consumption in Sinnar area, Blue Nile states in Sudan.

Methods  A survey of CE in livestock was conducted from April 2009 to March 2011 in Sinnar area, Blue Nile state in Sudan. Location, parasitological status and fertility conditions were determined. In addition, 120 hydatid cysts (30 from camels, 62 from cattle and 28 from sheep) were examined by polymerase chain reaction (PCR) and mitochondrial gene sequencing for the genetic allocation of Echinococcus strains or species

Results  The prevalence of CE was 29.7% (30/101) in camels, 2.7% (62/2310) in cattle and 0.6% (26/4378) in sheep. It was shown that infection rates increased with age in camels, cattle and sheep. In camels, 67% (20/30) of the infected animals were aged between 2–5 years whereas 58% (36/62) of the infected cattle were >5 years. In sheep, the prevalence rate was distributed equally between animals ranging 2–5 years and >5 years. Even though multiple cysts were found in some animals, the average number of cysts per animal was close to 1 in all examined species. Lungs were found to be the predilection sites for the parasite in both camels and cattle, while most of the cysts found in sheep were located in the liver. About 63.4% of cysts encountered in camels were considered as large (5–7 cm), whereas those in cattle and sheep were medium (2–4 cm) and small (<2 cm) respectively. The highest fertility rate was found in camel cysts with 85.4% (35/41) followed by cattle (50.0%, 32/64) and sheep (39.0%, 11/28). All examined cysts belonged to Echinococcus canadensis G6, which was confirmed to be the overwhelmingly predominant species in that area.

Conclusion  The epidemiological situation in Sinnar area, Blue Nile state is characterized by intense transmission of Echinococcus canadensis G6, thereby closely resembling the situation in most other regions of Sudan.

     

复发性肝包虫病经完整外囊摘除和内囊摘除术后复发率的比较

目的:通过随访观察来对比肝包虫外膜内外囊完整摘除术与常规内囊摘除术在治疗复发性肝包虫后的复发率,来评价其临床应用价值.方法:对我院8年间(1999 年～2007年)再次入院的复发肝包虫病患者70例,将其分为两组:A组30例:保留外囊的传统术式组;B组40例:外膜内外囊完整摘除术(新术式).对临床观察指标原位复发率进行统计分析.随访时间中位数为36月(3月～96月).结果:外膜内完整外囊摘除术式组原位复发率低于传统术式(P<0.05).结论:外膜内完整外囊摘除术式能降低复发病例的再次手术复发率.