肝包虫病的外科治疗

目的 分析、探索肝囊型包虫病(cystic echinococcosis,CE)手术治疗的方式、适应证及其疗效。方法 分析我院2009-2013年手术治疗的肝囊型包虫患者216例。结果 内囊摘除术(A组) 术后平均住院d数、带管时间、术后残腔并发症等均显著高于其他3组(P＜0.01);手术D组的手术耗时及出血量、住院费用等均显著高于其他3组(P＜0.01)。结论 ①肝包虫外囊完整剥除术治疗可根除因内囊摘除术导致包虫复发和胆瘘等并发症;同肝切除相比具有创伤较小、并发症减少的特点,故可为CE手术治疗的首选;②对于邻近大血管、重要脏器组织或周围解剖层次不清的肝包虫,外囊次全切除术可在有效消灭残腔的同时,减少手术难度及外囊剥除术所引发手术风险。     

肝包虫病并感染致肾脏损害一例

正1病例介绍患者,女,29岁,新疆裕民县人,因发热后尿检异常近1月收住肾脏病科。2011-11-07开始出现反复发热伴食欲下降,6 d后在外院查尿检:蛋白(+++)、潜血(-)、白细胞(-),血肌酐69μmol/L,肺炎支原体(-),胸部X片提示肺部感染; B超提示肝右叶包虫。予以静脉滴注青霉素治疗肺部感染,服用退烧药物体温可降至正常,但仍然反复发热,体温最高39. 5℃。     

囊型肝包虫病并发其他脏器包虫病的B超诊断

囊型肝包虫病并发其他脏器包虫病的Ｂ超诊断王怀禄，孙厚坦，赵夏夏，程瑞萍，井茹芳（兰州军区总医院超声科兰州７３００５０）包虫病是棘球绦虫的蚴虫寄生在人体所致的寄生虫病，可在人体的任何部位发病。我科Ｂ超诊断并经手术病理证实囊型肝包虫１１１例，其中３１例同...     

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。     

囊型肝包虫病的临床基础研究进展

囊型肝包虫病是我国西北牧区常见的地方性疾病,手术仍然是治疗肝包虫的手段之一[1],近十年来,在一些国家开展了包虫外囊完整摘除的根治性手术,并取得了良好的效果[2-3].传统观念认为肝包虫囊肿周围纤维性囊壁(外囊)来源于人体,外囊与邻近脏器组织无明显的分界不能分开[4],故该术式是以不规则肝切除技术为基础,难度大、风险高开展受到限制[5-6].     

肝纤维化相关因子及其作用

肝纤维化是继发于肝脏炎症或损伤后组织修复的代偿反应,肝脏在受到外界因素刺激后, 肝组织中肝细胞与Kupffer细胞(KC)分泌可溶性的细胞因子,通过各自的信号转导途径,激活星状细胞(HSC)并使之处于持续激活状态, 激活的HSC分泌大量细胞外基质,使肝脏原有结构被破坏,形成肝纤维化．肝纤维化是可逆的,肝纤维化的治疗研究也是围绕着如何降低 HSC的活性,促进HSC凋亡,减少胶原的生成, 增加其降解,而这些过程均与细胞因子网络密切相关．     

腹腔镜联合胆道镜手术治疗肝包虫病患者初步疗效研究

目的 探讨腹腔镜联合胆道镜手术治疗肝包虫病患者的临床效果。方法 2015年2月~2016年8月在我院接受手术治疗的104例肝包虫病患者,52例接受经腹腔镜下内囊摘除术,另外52例采用经腹腔镜联合胆道镜内囊摘除术治疗,比较两组患者的治疗效果。结果 腹腔镜联合胆道镜手术患者胆漏检出率为80.8%,明显高于腔镜组的63.5%（P<0.05）;术中出血量为（33.2±20.8）ml,明显少于腔镜组的【（82.1±45.3）ml,P<0.05】;胆漏发生率、感染发生率、拔管时间、肠腔排气时间、住院日分别为9.6%、13.5%、（11.5±4.6） d、（1.8±0.7）d、（10.5±5.3）d,明显优于腔镜组的【34.6%、36.5%、（24.3±7.8）d、（3.3±0.6）d、（17.1±7.8）d,P<0.05】。结论 腹腔镜联合胆道镜手术治疗肝包虫病患者,效果确切,不良反应少,与传统单纯应用腹腔镜手术比,具有疗效好、创伤小、恢复快等优点。     

非霍奇金淋巴瘤预后相关免疫学因子研究进展

淋巴瘤的预后与很多因素有关,检测外周血中相关因子有助于研究淋巴瘤的预后。本文着重综述了与非霍奇金淋巴瘤预后相关的免疫学因子的研究进展。     

肝包虫病致反复发作急性胰腺炎1例

肝包虫病是棘球绦虫的幼虫棘球蚴寄生于人体肝脏所导致的一种慢性寄生虫病,可分为肝细粒棘球蚴病及肝泡状棘球蚴病,以肝细粒棘球蚴病多见。本病多见于畜牧区,是我国西北地区及西南地区常见病,患病率在0．5％～5．0％。肝包虫囊肿破入胆道临床表现易与其他疾病混淆,     

Orbital hydatid disease in Kenya

We treated 7 cases of orbital hydatidosis presenting as cysts. These were successfully treated surgically using a technique that does not compromise the eye and its visual function. This need arose when it was learned that 7 eyes had been enucleated and another case put on massive steroid therapy due to misdiagnosis as malignancies by ophthalmologists visiting in this country (M. French, African Medical Research Foundation, personal communication). It is imperative to stress the diagnostic and therapeutic aspects of this condition which must be considered in the differential diagnosis of unilateral proptosis.     

Granulomatous peritonitis in hydatid disease

We report a rare case of persisting granulomatous inflammation within the peritoneal cavity due to previous leakage from a liver hydatid cyst, with the granulomata bearing hooklets originating from protosolices of Echinococcus granulosus. The patient was treated with a full three-month course of albendazole. We believe this represents a rare case of 'pseudotuberculous peritonitis'.     

Albendazole in pulmonary hydatid disease

A case of bilateral pulmonary hydatid disease successfully treated with six courses of albendazole obviating need for surgery is being reported. No side-effects of the drug were observed. Though the cysts ruptured initially but disappeared completely. No recurrence has been observed.     

Immunodiagnosis of human hydatid disease

A study was undertaken to evaluate the efficacy of Enzyme Linked Immunosorbent Assay using locally prepared antigens for immunodiagnosis of human hydatid disease. A total of 90 cases clinically suspected to be suffering from hydatid disease and 100 controls matched for age and sex were included in the study. Two types of ELISA were performed on detected specific antihydatid antibodies belonging to IgG/IgM/IgA classes and other type detected IgE class of antibodies. Antigen prepared from the human hydatid fluid was found to be unsuitable for diagnosis as it contained host proteins i.e. IgG. Sheep hydatid fluid obtained from the fertile hydatid cyst was used to prepare and standardize the antigen. ELISA test to detect anti hydatid antibodies belonging to either IgG, IgM and or IgA was found to be highly specific (98 per cent) in surgically confirmed hydatid disease and was negative in all the controls. The results of the study indicate that ELISA along with casoni test may provide the best results in diagnosis of hydatid disease.     

The perforation problem in hydatid disease

Hydatidosis (echinococcosis) is endemic in the Mediterranean region, including Turkey. We evaluated the problem of perforation in hydatidosis. The clinical data on 21 patients with intra-abdominal hydatid cyst perforation who were treated in the last 10 years were evaluated retrospectively. Twelve patients (57%) were men and nine (43%) were women. Their average age was 40 (range = 20-65). Blunt trauma was the etiologic mechanism in four cases (19%). Except for a case with a cyst in the left inguinal region, most (95%) of the patients had primary hepatic hydatidosis (95%). The procedures used on the 30 cysts found in 21 patients were as follows: partial cystectomy and drainage in 21 (70%), total cystectomy in 5 (17%), partial cystectomy plus omentopexy in 2 (7%), and drainage plus vacuum obliteration in 2 (7%). The average postoperative hospital stay was 12 days (range = 6-30). Two patients (10%) had complications: an incisional hernia developed in one patient, and a gastrocutaneous fistula developed in the other. Albendazole (10 mg/kg/day) was prescribed for two months. The mean follow-up time was 80 months (range = 6-131). Three patients (14%) underwent additional surgery for recurrence at various times. The morbidity and mortality associated with perforated hydatid cysts were higher when compared with that of nonperforated cysts. Hydatidosis is endemic in Turkey and traffic accidents are common. When these factors coexist, hydatid perforation should be considered in trauma patients with stable hemodynamics, but suspicious abdominal findings. The choice of the operative approach should be based on the experience of the surgeon and regional characteristics.