肝细粒和多房棘球蚴混合感染3例

目的探讨肝细粒和多房棘球蚴混合感染患者诊断及手术治疗,为该类患者临床诊治提供经验。方法回顾性分析2017-2018年青海省人民医院诊断为肝细粒和多房棘球蚴混合感染患者的临床资料。结果共确诊3例肝细粒和多房棘球蚴混合感染患者。其中1例经术前CT检查确诊为细粒和多房棘球蚴混合感染,并在术中得到证实;另2例经术前彩超及影像学检查诊断为细粒棘球蚴病,但根据术中病灶形态和术后病理学确诊为细粒和多房棘球蚴混合感染。2例患者行根治性手术治疗,1例探查后仅行肝细粒棘球蚴内囊摘除、外囊次全切除术。结论肝细粒和多房棘球蚴混合感染患者术前易漏诊、误诊,影像学检查联合术后组织病理学检查结果才能最终确诊。肝细粒和多房棘球蚴混合感染患者手术相对复杂、困难,针对不同感染类型患者应采取个体化手术治疗方案。     

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］     

手术治疗钙化型肝细粒棘球蚴病的效果观察

目的探讨手术治疗钙化型肝细粒棘球蚴病的临床效果。方法回顾性分析2015年11月-2019年2月于石河子大学医学院第一附属医院行手术治疗(外囊完整剥除术、外囊次全切除术及内囊摘除术)的16例共20个钙化型肝细粒棘球蚴囊肿的临床特点及治疗效果。结果 1例患者行外囊完整剥除术,5例患者行内囊摘除术,10例患者行外囊次全切除术。除1例患者因术前囊肿已破入胆道且外囊壁已存在胆瘘而于术后发生胆漏之外,其余患者术后均未发现残腔积液、感染等残腔并发症及胆漏、黄疸。术后均无死亡、复发病例。结论对于非静止期的钙化型肝细粒棘球蚴病必须手术治疗,外囊完整剥除术并不适用,可优先选用外囊次全切除术,尤其是当出现钙化型肝细粒棘球蚴囊肿邻近肝门部、邻近肝内外大血管及外膜与外囊之间的潜在性腔隙不明显时。而当出现肝细粒棘球蚴囊肿破裂时,可酌情选择内囊摘除术。     

小鼠肝细粒棘球蚴和多房棘球蚴病不同时期病灶周围组织纤维化对比

目的 本实验通过研究对比不同时间两种肝棘球蚴病灶周围组织纤维化情况,进一步了解肝棘球蚴病的病理生理发展过程,为肝棘球蚴病的诊治提供参考。方法 建立动物模型,使用HE,Masson染色以及COL1,COL3、α-SMA、TGF-β1免疫组化染色对比观察两种肝棘球蚴病在不同时间纤维化情况的不同。结果 随着时间的变化肝细粒棘球蚴病灶周围纤维化由弥漫到聚集,可形成连续致密的纤维外膜;肝多房棘球蚴病灶周围组织纤维化始终为弥漫性,无法形成连续质密的纤维外膜。细粒棘球蚴组病灶周围COL1(r=-0.768,P<0.05)、COL3(r=-0.781,P<0.05)、α-SMA(r=-0.867,P<0.05)、TGF-β1(r=-0.854,P<0.05)的表达强度与时间呈负相关,多房棘球蚴组病灶周围COL1(r=-0.349,P>0.05)、COL3(r=-0.037,P>0.05)、α-SMA(r=-0.107,P>0.05)、TGF-β1(r=-0.148,P>0.05)的表达强度与时间无相关性。 无相关性同时观察到两种包虫周围细胞外基质胶原含量不同,细粒棘球蚴组I、III型胶原比高于多房棘球蚴组(Z=-3.23,P<0.05)。结论 相较于多房棘球蚴,细粒棘球蚴病灶周围可产生连续致密的纤维外囊。细粒棘球蚴在外囊形成后纤维化进程减弱或停止,多房棘球蚴在整个病程中均有活跃的纤维化反应。细粒棘球蚴相较于多房棘球蚴外囊的I/III型胶原比值较高。     

肝细粒棘球蚴外囊壁钙化相关受体

目的 比较肝细粒棘球蚴病患者钙化外囊壁及非钙化外囊壁上的钙化相关受体BMPRⅡ(骨形态发生蛋白Ⅱ型受体)、IGF1R(胰岛素样生长因子1受体)和ERα(雌激素受体α)的表达差异。方法 钙化外囊壁和非钙化外囊壁茜素红染色,Envision免疫组化法和qRT-PCR分别检测同一细粒棘球蚴病患者钙化外囊壁及非钙化外囊壁上钙化相关受体BMPRⅡ、IGF1R和ERα的表达水平和钙化相关受体的mRNA表达量。结果 与细粒棘球蚴非钙化外囊壁相比较,同一患者钙化外囊壁茜素红染色钙化显著,且差异有统计学意义(χ²=20.369,P<0.01);钙化外囊壁相关受体的表达明显增加,且差异有统计学意义(P<0.05),mRNA表达量明显增高且差异具有统计学意义(P<0.05)。结论 肝细粒棘球蚴病患者钙化外囊壁钙化相关受体表达量较高,钙化相关因子通过与受体BMPRⅡ、IGF1R和ERα等结合,引起细粒棘球蚴外囊壁钙化,外囊壁的钙化可以有效地抑制细粒棘球蚴的生长,在细粒棘球蚴病患者临床治疗过程中发挥着重要作用。     

腹壁细粒棘球蚴病1例

腹壁细粒棘球蚴病较为罕见,本文报道了1例腹壁细粒棘球蚴病患者。该患者因发现腹部包块1年、伴包块皮肤破溃5 d,以“腹壁细粒棘球蚴病”收住入院,行腹壁下细粒棘球蚴病内囊摘除术,术后病理为细粒棘球蚴病（单房多子囊型）。本文旨在为腹壁细粒棘球蚴病临床诊断和治疗提供经验。     

2022年全国棘球蚴病防治工作进展

为掌握全国棘球蚴病防治进展,总结防治经验,发现存在的问题,对2022年全国棘球蚴病防治工作数据进行描述性分析。截至2022年底,全国共有370个棘球蚴病流行县（市、区、旗） 29 926个流行村。2022年全国流行县（市、区、旗）现有棘球蚴病患者25 227例,平均患病率为58.35/10万（25 227/43 232 609）。细粒棘球蚴病15 554例,多房棘球蚴病8 169例,混合感染255例,未分型1 249例。新发现棘球蚴病患者1 270例,其中细粒棘球蚴病991例,多房棘球蚴病89例,混合感染5例,未分型185例;<12岁人群102例,≥12岁人群1 168例。2022年,全国棘球蚴病流行省（自治区）共开展人群腹部超声筛查3 576 121人次,其中,<12岁人群筛查751 440人次,≥12岁人群筛查2 824 681人次;血清学检测超声筛查疑似人员17 404人次。2022年370个监测点<12岁人群超声筛查患病率为0.02%(60/287 437),其中新发现患者占患者数的40.00%(24/60)。Ⅰ、Ⅱ类流行县（市、区、旗）监测点≥12岁人群超声...     

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。     

2021年全国棘球蚴病防治进展

为掌握全国棘球蚴病防治进展，对2021年全国棘球蚴病防治工作数据进行了汇总和分析。截至2021年底，全国共有370个棘球蚴病流行县（市、区、旗） 30 421个流行村，流行乡常住人口4 758.41万人。2021年全国流行县（市、区、旗）现有棘球蚴病患者26 773例，平均患病率为0.06%(26 773/47 584 117)，其中细粒棘球蚴病16 625例，多房棘球蚴病8 327例，混合感染311例，未分型1 510例；新发现棘球蚴病患者1 346例，其中细粒棘球蚴病1 075例，多房棘球蚴病86例，混合感染7例，未分型178例；<12岁人群147例，≥12岁常住人群1 199例。2021年，全国棘球蚴病流行省（自治区）共开展人群腹部超声筛查447.17万人次，其中，<12岁人群筛查87.15万人次，≥12岁常住人群筛查360.02万人次；血清学检测11 358人次。2021年370个监测点<12岁人群超声筛查患病检出率为0.02%(72/336 959)，其中新发现患者占检出患者数的58.33%(42/72)；≥12岁常住人群中，Ⅰ、Ⅱ类流行县（市、区、旗）监测...     

青海省达日县棘球蚴病流行病学调查

目的 分析青海省果洛藏族自治州达日县棘球蚴病的流行分布现状,为制定预防控制措施提供科学依据。 方法 于2007年8～9月对达日县6个乡各2～3个自然村的3周岁以上常驻牧民分别用B超、间接红细胞凝集试验（IHA）和间接ELISA法（重组Ag B和Em 18抗原）检查两型棘球蚴病患病和感染情况。并调查当地啮齿类动物、牦牛、绵羊和野犬的感染情况,对采集的棘球绦虫和棘球蚴用PCR-RFLP方法进行虫种鉴定,并确定其基因型。收集牧民的家犬粪便,用双抗体夹心法检测粪抗原阳性率。 结果 共调查牧民1 723人,B超查出棘球蚴病患者236例（占13.7%）,其中囊型和泡型棘球蚴病患病率分别为5.5%（95/1 723）和8.2%（141/1 723）。男、女性棘球蚴病患病率分别为11.6%和16.0%（χ ²=7.0,P＜0.05）。家犬粪抗原阳性率为11.3%（31/275）。剖检9只无主犬,其中5只棘球绦虫感染阳性,对检获的虫体经PCR-RFLP鉴定,1只犬感染细粒棘球绦虫,基因型为G1,4只犬感染多房棘球绦虫。牦牛、绵羊的细粒棘球蚴感染率分别为26.4%（14/53）和5/16,对从牦牛、绵羊检获的细粒棘球蚴经PCR-RFLP鉴定,基因型均为G1。捕获高原鼠兔239只,石渠棘球绦虫感染率为11.3%（27/239）。 结论 达日县存在细粒棘球绦虫、多房棘球绦虫和石渠棘球绦虫的分布,泡型和囊型棘球蚴病在人群中严重流行,犬是细粒棘球绦虫和多房棘球绦虫主要传染源。     

包虫病影像诊断技术和手术治疗进展

包虫病是严重危害中国西部人群的人兽共患寄生虫病,手术仍为包虫病临床最主要的治疗手段.该文通过对囊型包虫病和泡型包虫病等两型肝包虫病的影像学诊断和各种术式回顾性分析总结后,综述如下:1)超声检查主要用在两型包虫病的诊断与鉴别诊断,尤其是在农牧区进行流行病学调查和普查时,超声以其便携低耗易行的特点成为首选.近来用超声对肝两型包虫病病灶在二维超声、彩色多普勒血流成像的基础上进行灰阶超声造影检查,超声造影可以更好地显示其病灶的确切范围,周边增值带微循环血供状态,为肝包虫病外科手术提供更多的诊断治疗信息.2)囊型包虫病CT/MRI均表现为境界清楚的囊肿,病程发展中出现子囊、囊膜剥离、囊壁及内容物钙化等特征;泡型包虫病CT/MRI均表现为非均质实性肿块,内部有小圈状和颗粒状钙化,中心常出现液化坏死,形成"地图状"外观.其类似肿瘤的浸润生长可压迫和侵蚀肝血管和胆管并伴远处血行转移.MRI水成像技术对不典型包虫病有独特的诊断效果;CT/MRI血管成像和胆系成像有利于诊断包虫并发症;CT/MRI灌注技术、MRI扩散成像和波谱成像有望实现活体无创的分子影像诊断.3)肝囊型包虫病:(1)肝包虫外囊完整剥除术是理想的治疗方法,值得推广的首选术式;(2)外囊次全切除术可有效消减残腔,避免胆瘘等,能减少手术时间及外囊完整剥除术所致手术风险;(3)肝内囊摘除术仍是主要方法,术中应经胆道或胆囊管美蓝造影以确认是否胆漏.4)肝泡型包虫病:(1)根治性肝切除是治疗首选方法;(2)姑息性病灶切除手术,因继发难治性肝切面胆瘘而宜慎重采用;(3)肝移植是治疗两型包虫病终末期最后手段,术后仍存在复发的可能,需酌情服用抗包虫药,如阿苯达唑片剂或其他剂型(乳剂、脂质体口服液等).     

Post-survey follow-up for human cystic echinococcosis in northwest China

In Hobukesar, Xinjiang Uygur Autonomous Region, (China), a mass-screening programme for human cystic echinococcosis (CE)was performed during 1995 and 1996. After the survey 51 cases were followed-up using ultrasound scan and serology for 1-8 years(1996-2003). These included 20 CE cases treated by surgery (endocystectomy), four CE cases treated by percutaneous drainage(PAIR), six untreated CE cases, five ultrasound 'query' cases, eight cases of isolated hepatic calcifications, four previous CE surgery cases whose ultrasound was now normal, and four seropositive cases who exhibited a normal hepatic ultrasound. Follow-up results indicated that in the untreated CE patients, one case exhibited a spontaneous cure within 4 years, another case changed from a hepatic hydatid cyst that contained a floating laminated membrane (type CE3) to a cyst that contained daughter cysts (type CE2)within 1 year of follow-up. In the 20 surgically treated cases, two recurrent CE cases occurred within 4 years, and five cases had had residual cavities for more than 4 or 8 years. Of the 4 PAIR treated cases, two recurrent cases of CE occurred within 4 or 8 years of follow-up. Serological follow-up data showed that specific IgG antibody levels were persistently positive in most CE cases, but exhibited a decreasing tendency in cases that were effectively treated by surgery; In contrast, serum IgG levels in the PAIR group or in the recurrent CE cases after surgery exhibited an increasing tendency. At least one persistent seropositive case with an isolated hepatic calcification was considered to be abortive CE.     

肝细粒棘球蚴病下腔静脉 肝静脉CT成像的评估价值

目的 探讨使用CT成像评估肝细粒棘球蚴病病灶与下腔静脉、肝静脉关系的准确性。 方法 100例肝细粒棘球蚴病患者行腹部CT三期扫描,得到下腔静脉、肝静脉三维重建图像,观察棘球蚴病病变与下腔静脉、肝静脉的关系,将结果与术中结果对比,分析使用CT成像评估肝细粒棘球蚴病病灶侵犯下腔静脉、肝静脉的可靠性。结果 CT成像评估血管推移、伴抱球征、界限不清楚、血管狭窄等与术中所见一致。有4例患者CT成像判断为病灶与下腔静脉界限清楚,而术中示病灶与血管有一定黏连。对于有血管狭窄判断为受侵犯的结果中,有3例为过度诊断。结论 肝静脉、下腔静脉CT成像能清晰显示肝棘球蚴囊肿与肝静脉、下腔静脉的空间位置关系。     

A correlative study of ultrasound with serology in an area in China co-endemic for human alveolar and cystic echinococcosis

We correlated ultrasound (US) imaging classifications for human alveolar echinococcosis (AE) and cystic echinococcosis (CE) with serology (ELISA and immunoblotting (IB) incorporating native and recombinant/purified echinococcal antigens) in community surveys (2001-2003) and follow-up (2002 and 2003) of US-confirmed cases in Ningxia, China. One hundred and seventy-one cases (96 with AE, 75 with CE) were identified; of these, US classification and serological data were obtained for 142 and 112 cases, respectively. Seropositive-rates increased in CE patients with highly viable unilocular cyst lesions (Types CL, CE 1 or CE 2) to degenerating primary lesions (CE 3), but then decreased in subjects with inactive (CE 4) or dead (CE 5) cysts. In contrast, there was a constant increase in seropositivity from the early (P1, P2) to the advanced stages (P3, P4) with AE cases. For US-confirmed cases, follow-up by US combined with serology is invaluable for studying the clinical progression of echinococcosis and for detecting recurrent cysts or reinfection post-treatment.     

25例肝包虫囊肿破入胆道的诊治体会

目的探讨肝包虫囊肿破入胆道的诊断及治疗方式。方法回顾分析我院2001年～2011年行手术治疗的25例肝包虫囊肿破入胆道患者的临床表现、实验室检验、影像学检查、手术方式及治疗效果。结果超声、CT、磁共振胰胆管成像(MRCP)及内镜逆行胰胆管造影(ERCP)对于肝包虫囊肿破入胆道均具有良好的诊断价值,其中ERCP诊断价值最高,确诊率可达100%。25例患者中22例手术方式为胆囊切除、胆总管探查、T管引流+肝包虫残腔引流,其余3例行胆囊切除、胆总管探查、T管引流+肝包虫病灶根治性切除。所有患者均痊愈出院。结论超声因普及易行,应作为诊断肝包虫囊肿破入胆道的首选辅助检查,MRCP检查具有诊断准确率高和无创等优点,ERCP则对肝包虫囊肿破入胆道诊断率最高。胆囊切除、胆总管探查、T管引流+肝包虫残腔引流应作为肝包虫囊肿破入胆道首选手术方式,对于部分复杂病例可行胆囊切除、胆总管探查、T管引流+肝包虫病灶根治性切除,效果良好。     

Recombinant AgB8/1 ELISA test vs. commercially available IgG ELISA test in the diagnosis of cystic echinococcosis

The diagnosis and clinical management of cystic echinococcosis (CE) rely on imaging and serology, the latter still having a complementary role as its accuracy in assessing cyst viability is unsatisfactory. We used an experimental IgG ELISA test based on the recombinant antigen rEgAgB8/1 cloned from Echinococcus granulosus to differentiate active from inactive/cured CE infection, comparing its performance to that of a commercially available ELISA test used routinely in our hospital laboratory. Both tests were performed on sera from 88 patients with hepatic echinococcal cysts, grouped according to cyst stage based on ultrasonographical morphology, and on 17 patients surgically treated for echinococcosis and 18 patients with nonparasitic hepatic cysts included as controls. Tests’ performances did not differ significantly, but the overall concordance between tests drastically dropped when groups were analysed separately. Further longitudinal studies should evaluate whether these discrepancies reflect the different ability of either test to predict the evolution of cysts over time. Although the recombinant‐AgB8/1‐based ELISA test seems to have no clinical advantage over the commercially available ELISA test in the assessment of hepatic CE cyst viability, the easiness of production and reproducibility of high‐quality recombinant antigens makes rEgAgB8/1 a valid candidate for use in CE ELISA diagnostic tests.     

Cystic echinococcosis of the liver and lung treated by radiofrequency thermal ablation： An ex-vivo pilot experimental study in animal models

AIM： To evaluate radiofrequency thermal ablation （RTA） for treatment of cystic echinococcosis in animal models （explanted organs）.
METHODS： Infected livers and lungs from slaughtered animals, 10 bovine and two ovine, were collected. Cysts were photographed, and their volume, cyst content, germinal layer adhesion status, wall calcification and presence of daughter or adjacent cysts were evaluated by ultrasound. Some cysts were treated with RTA at 150 W, 80℃, 7 min. Temperature was monitored inside and outside the cyst. A second needle was placed inside the cyst for pressure stabilization. After treatment, all cysts were sectioned and examined by histology. Cysts were defined as alive if a preserved germinal layer at histology was evident, and as successfully treated if the germinal layer was necrotic.
RESULTS： The subjects of the study were 17 cysts （nine hepatic and eight pulmonary）, who were treated with RTA. Pathology showed 100% success rate in both hepatic （919） and lung cysts （8/8）; immediate volume reduction of at least 65%; layer of host tissue necrosis outside the cyst, with average extension of 0.64 cm for liver and 1.57 cm for lung; and endocyst attached to the pericystium both in hepatic and lung cysts with small and focal de novo endocyst detachment in just 3/9 hepatic cysts.
CONCLUSION： RTA appears to be very effective in killing hydatid cysts of explanted liver and lung. Bile duct and bronchial wall necrosis, persistence of endocyst attached to pericystium, should help avoid or greatly decrease in v/vo post-treatment fistula occurrence and consequent overlapping complications that are common after surgery or percutaneous aspiration, injection and reaspiration. In vivo studies are required to confirm and validate this new therapeutic approach.     

Long-term Follow-up of a Patient with Portal Hypertension and Hepatic Failure Due to Hepatic Hydatid Disease

We observed liver failure with a presumed etiology of echinococcosis in an 89-year-old woman. Our patient had been born and then resided on Rebun Island until she was 12 years old. At 46 years old, she had been referred to our hospital due to right abdominal pain. Ultrasound had revealed multilocular cysts in the right lobe of the liver. At 84 years old, the hepatic cyst occupied nearly the entire liver with ring-shaped calcification along the cyst wall. The patient was diagnosed with decompensated cirrhosis and hepatic hydatid disease based on typical imaging and the long-term natural clinical course.     

肝包虫病与肝囊肿CT表现比较*

目的 探讨使用256排CT检查在鉴别肝包虫病与肝囊肿方面的临床价值。方法 2017年4月～2020年11月我院诊治的肝囊肿患者77例和肝包虫病患者34例接受256排CT增强扫描检查,采用ELISA法检测血清抗囊液抗原抗体(EgCF)、抗头节抗原抗体(EgP)、抗囊液半纯化抗原抗体(EgB)和抗泡球蚴抗体(Em2)。结果 本组肝包虫病患者术前血液嗜酸性粒细胞计数为(0.3±0.1)×10⁹/L,显著高于肝囊肿患者【(0.1±0.1)×10⁹/L,P＜0.05】;肝包虫病患者血清抗EgCF抗体和抗EgB抗体阳性率分别为85.3%和61.8%,均显著高于肝囊肿患者【分别为31.2%和0.0%,P＜0.05】;增强CT扫描,肝包虫病患者肝内存在类圆形、圆形或分叶状囊性灶,囊壁钙化;在入组的111例患者中,CT检查将3例(2.7%)肝包虫病误诊为肝囊肿,1例(1.0%)肝包虫病被误诊为肝转移癌,2例(1.8%)肝囊肿被误诊为肝包虫病。结论 CT检查能很好地显示肝包虫病囊性病灶的影像学特征,对鉴别肝包虫病与肝囊肿有帮助,为临床治疗提供可靠的影像学依据。     

扩散加权成像技术在肝脏囊性病变中的应用

目的探讨MR扩散加权成像(DWI)及表观扩散系数(ADC)值在肝脏囊性病变诊断中的价值。方法对50例肝囊性病变患者行DWI检查,并测量ADC值。包括单纯性肝囊肿15例、单房囊肿型肝包虫病15例、脓腔形成期肝脓肿10例、囊性坏死性肝转移瘤10例。结果单纯性肝囊肿、单房囊肿型肝包虫病、脓腔形成期肝脓肿、囊性坏死性肝转移瘤ADC值分别为(3.85±0.23)×10-3 mm2/s、(3.52±0.53)×10-3 mm2/s、(1.069±0.1)×10-3 mm2/s、(2.159±0.14)×10-3 mm2/s,单纯性肝囊肿、单房囊肿型肝包虫病、脓腔形成期肝脓肿、囊性坏死性肝转移瘤ADC值差异有统计学意义(P<0.05)。在DWI图像上,脓腔形成期肝脓肿、囊性坏死性肝转移瘤呈高信号,而单纯性肝囊肿、单房囊肿型肝包虫病均呈低信号。结论分析DWI图像特点及ADC值在肝脏囊性病变中的鉴别诊断有重要价值。