手术治疗邻近肝门部肝细粒棘球蚴病效果观察

目的 探讨手术治疗邻近肝门部的肝细粒棘球蚴病的效果。方法 回顾性分析2015年 11月至 2019年1月行外囊完整剥除术、外囊次全切除术及内囊摘除术的 20例共36个邻近肝门部的肝棘球蚴囊肿的手术疗效。结果 4个肝棘球蚴囊肿成功行外囊完整剥除术,30个肝棘球蚴囊肿成功行外囊次全切除术,2个肝棘球蚴囊肿因外囊与肝门血管粘连过于紧密且已经破裂入胆道而行内囊摘除术。肝门部大血管均保存完整,除1例因术前肝棘球蚴囊肿破裂入胆道(行内囊摘除术)而出现术后胆漏以外,余均无残腔并发症发生。结论 对于邻近肝门部的肝细粒棘球蚴病的手术治疗,外囊次全切除术与外囊完整剥除术较传统的内囊摘除术,术后胆漏、残腔感染等并发症发生率相对较低,可优先选择。但是还应根据囊肿的部位、大小及手术中具体情况选择具体的手术方式。     

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。     

检测包虫病患者血清特异IgG4诊断价值的研究

目的探讨检测患者血清特异IgG4诊断包虫病的效果.方法采用两种抗原(棘球蚴囊液粗抗原及其抗原B)通过ELISA法检测棘球蚴病病人、非棘球蚴病病人和健康对照血清特异IgG4.结果粗抗原和抗原B检测棘球蚴患者血清特异IgG4的阳性率分别为94.4%和89.8%;与部分猪囊尾蚴病患者血清出现交叉反应外,与肺吸虫病、旋毛虫病、血吸虫病、肝囊肿等患者的血清以及健康对照血清均未出现交叉反应.结论检测棘球蚴患者血清特异IgG4敏感性高,特异性强,具有较好的诊断价值.     

青海省果洛州人与动物棘球蚴病调查

目的通过对青海省果洛州人群与动物棘球蚴病的调查与分析,了解当地棘球蚴病在人群和动物中的流行与分布状况。方法应用B超对人群进行患病率调查;囊液抗原间接血凝试验(IHA)法筛查人群棘球蚴抗体的阳性率;并分别用重组Em18(rEm18)、重组抗原B(rAgB)和Eg囊液抗原(EgcF),对随机选取的B超检查和IHA检测阳性者进行ELISA试验,与B超诊断结果进行符合率比较,评价泡型棘球蚴病(AE)、囊型棘球蚴病(CE)的分布情况;应用ELISA检测家犬和藏狐粪抗原阳性率;现场检查牛、羊胸腹腔,确定牛、羊感染率。结果人群调查:①B超检查2826人,总患病率为9.45%。血清IHA法检查1113人,阳性率25.79%。女性人群的患病率和血清阳性率均显著高于男性;②血清囊液抗原IHA检测阳性者(108)与ELISA法检测EgcF,阳性符合率为66.94%;3种重组抗原检测,ELISA法与IHA法阳性符合率为75.00%。③B超法诊断棘球蚴病(88人)与ELISA法检测,符合率EgcF为94.32%,rAgB为68.18%,rEm18为5l-4%。EgcF阳性率符合率为69.44%;3种抗原检测与IHA检测总体阳性符合率为75.00%。61例CE患者中,血清ELISA法检测,EgcF阳性率为96.72%,rAgB为68.85%,rEm18为33.33%;26例AE患者中,EgcF和rEm18阳性率均为92.31%,rAgB为65.39%。动物调查:①高原鼠兔棘球蚴感染率21.74%。经cytb基因分析,证实有多房棘球绦虫(E.multilocularis)和石渠棘球绦虫(E.shiquicus)感染。绵羊棘球蚴感染率82.61%,牦牛棘球蚴感染率78.52%。②野犬、藏狐、猞猁均有不同程度的棘球绦虫感染。结论青海省果洛州人群与动物中存在棘球蚴病的高度流行。E.shiquicus种的幼虫和成虫分别在高原鼠兔和藏狐体内寄生已得到证实,提示果洛州为3种棘球蚴的混合流行区。     

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。     

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。     

79例肝棘球蚴病患者影像学分析

目的 回顾性分析79例肝棘球蚴病患者的影像学表现,为该病诊断与鉴别诊断提供参考。方法 收集2014-2017年在青海省人民医院行影像学检查并经病理检查证实的79例肝棘球蚴病患者病历资料,对其影像学表现进行回顾性分析。结果 79例肝棘球蚴病患者中,细粒棘球蚴病57例,多房棘球蚴病22例;细粒棘球蚴病患者中,单囊型21例,多子囊型16例,内囊塌陷型9例,实变型4例,钙化型7例。79例患者中,62例为常见影像学征象。单囊型细粒棘球蚴病表现为肝内囊性水样病灶,囊壁薄厚均匀、无强化;多子囊型表现为“囊中囊”、“玫瑰花瓣”、“轮辐征”等;当内囊塌陷分离时表现为“飘带征”、“双环征”等征象;囊壁钙化时呈弧线状、蛋壳状,囊内容物呈现絮状或者整个病灶钙化。多房棘球蚴病表现为肝内实性肿块,密度及信号不均匀,边缘不规则;病灶强化不明显,病灶内散在或者群簇状分布的“小囊泡”,常伴有钙化,整个病灶呈“地图样”外观。另外17例患者表现为复杂少见的影像征象;其中6例细粒棘球蚴病囊内含脂肪,影像表现为囊内单发或多发脂肪密度结节灶,CT值为-28～-84 HU;4例病灶破入胆管,邻近胆管密度增高,胆管壁增厚,周围胆管扩张;4例合并原发性肝癌,影像表现为肝内细粒或多房棘球蚴病合并实性强化肿块,增强呈“快进快出”表现;3例合并感染,影像学表现为囊壁明显增厚且强化明显,其中2例囊内见气体影,1例囊肿合并感染并侵及腹壁。结论 肝棘球蚴病影像学表现复杂多样,在临床工作中需认真分析,做好鉴别诊断。     

单克隆抗体竞争性ELISA诊断人棘球蚴病的评价

用对流免疫电泳(IEP)及常规ELISA诊断细粒棘球蚴病时,对某些寄生虫可出现交叉反应。本文采用特异性高的棘球蚴抗原5(Ag5)和抗原B(AgB)结合敏感性高的单克隆抗体(McAb)作竞争性ELISA,以改进常规方法,用于人棘球蚴病的诊断。将羊的棘球蚴囊液(SHCF),离心过滤,     

检测棘球蚴病患者血清内循环抗原的免疫层析试条的制备和评价

目的 以棘球蚴囊液纯化抗原特异性单克隆抗体为基础建立一种快速、简便诊断棘球蚴病的胶体金免疫层析试条方法,并对其进行评价。方法 纯化棘球蚴囊液抗原,并以此免疫BALB/c小鼠,采用杂交瘤技术制备单克隆抗体,对所制备的单克隆抗体确定其亚类和效价。筛选基于棘球蚴囊液纯化抗原制备的单克隆抗体对,采用柠檬酸三钠还原法制备胶体金颗粒,标记筛选到的单克隆抗体,并将其吸附于交联垫;将另一筛选到的单克隆抗体划线包被于同一硝酸纤维素膜适当位置,制成免疫层析试条。用该试条检测手术确诊的细粒棘球蚴病(87例)、多房棘球蚴病(40例)、囊尾蚴病(25例)、日本血吸虫病(10例)、弓形虫病(5例)、并殖吸虫病(5例)、华支睾吸虫病(5例)患者血清,以及60例健康者血清,以评价其检测的敏感性和特异性。结果 以棘球蚴囊液纯化抗原为免疫源制备单克隆抗体,共筛选了11株能高效分泌效价在1∶25 600～1∶102 400特异抗体的细胞株,抗体亚类为IgG₁或IgG_2a。筛选到的单克隆抗体F₃B₆作为标记抗体,单克隆抗体C_4<...     

一种细粒棘球绦虫抗原基因克隆的表达及诊断价值分析

棘球蚴病(CHD)的诊断主要依靠免疫学方法,但由于使用的抗原为棘球蚴囊液粗抗原,因此交叉反应较多。用重组的细粒棘球绦虫抗原作代替抗原是一项重要的改进。本文作者分离了一种编码细粒棘球绦虫抗原的cDNA序列,并对其潜在的诊断价值进行了分析。     

2011-2018年宜兴市棘球蚴病监测

目的　分析2011-2018年江苏省宜兴市棘球蚴病监测结果,为该市棘球蚴病防治提供参考依据。方法　在中国疾病预防控制中心传染病报告信息管理系统中,对宜兴市2007年以来报告的棘球蚴病病例进行个案调查。2011-2018年,对宜兴市芳东村和芳庄村常住人口以及羊肉交易市场从业人员进行血清学抗棘球绦虫抗体检测和腹部B超筛查,同时检查羊肉交易市场屠宰羊只肝、肺脏是否存在囊状物、包块或结节,并收集芳东村和芳庄村家犬粪便进行棘球绦虫抗原检测。此外,2011-2018年每年均采用调查表对上述监测人群开展棘球蚴病防治知识知晓情况调查。结果　自2007年以来,宜兴市共报告7例棘球蚴病病例,患病率为0.56/10万人;7例均为细粒棘球蚴病患者,其中2例有流行区旅行史,5例有本地羊肉市场从业史或养犬史。2011-2018年共对1 861人开展人群血清学调查,血清抗棘球绦虫抗体阳性率为0.54%,2016年后未检出阳性;对1 807人开展腹部B超筛查,发现可疑囊肿143人（7.91%）,可疑者血清学检测阳性率为1.40%（2/143）。2011-2018年共检测家犬粪便446份,棘球绦虫抗原检出率为0.67%（3/446）;共触诊或肉眼观察羊肉交易市场屠宰羊肝、肺脏4 010份,检出囊状物、结节7份,平均检出率为0.17%。2011-2018年共对538人进行棘球蚴病防治知识知晓情况调查,平均知晓率为76.95%（414/538）,各年知晓率总体呈逐年上升趋势。结论　宜兴市棘球蚴病患病率和人群血清抗棘球绦虫抗体阳性率较低,但存在棘球蚴病流行风险,应持续加强监测并采取相应防控措施。     

2011-2018年宜兴市棘球蚴病监测

目的　分析2011-2018年江苏省宜兴市棘球蚴病监测结果，为该市棘球蚴病防治提供参考依据。方法　在中国疾病预防控制中心传染病报告信息管理系统中，对宜兴市2007年以来报告的棘球蚴病病例进行个案调查。2011-2018年，对宜兴市芳东村和芳庄村常住人口以及羊肉交易市场从业人员进行血清学抗棘球绦虫抗体检测和腹部B超筛查，同时检查羊肉交易市场屠宰羊只肝、肺脏是否存在囊状物、包块或结节，并收集芳东村和芳庄村家犬粪便进行棘球绦虫抗原检测。此外，2011-2018年每年均采用调查表对上述监测人群开展棘球蚴病防治知识知晓情况调查。结果　自2007年以来，宜兴市共报告7例棘球蚴病病例，患病率为0.56/10万人；7例均为细粒棘球蚴病患者，其中2例有流行区旅行史，5例有本地羊肉市场从业史或养犬史。2011-2018年共对1 861人开展人群血清学调查，血清抗棘球绦虫抗体阳性率为0.54%，2016年后未检出阳性；对1 807人开展腹部B超筛查，发现可疑囊肿143人（7.91%），可疑者血清学检测阳性率为1.40%（2/143）。2011-2018年共检测家犬粪便446份，棘球绦虫抗原检出率为0.67%（3/446）；共触诊或肉眼观察羊肉交易市场屠宰羊肝、肺脏4 010份，检出囊状物、结节7份，平均检出率为0.17%。2011-2018年共对538人进行棘球蚴病防治知识知晓情况调查，平均知晓率为76.95%（414/538），各年知晓率总体呈逐年上升趋势。结论　宜兴市棘球蚴病患病率和人群血清抗棘球绦虫抗体阳性率较低，但存在棘球蚴病流行风险，应持续加强监测并采取相应防控措施。     

Humoural immune response and pathological analysis in patients with false immune diagnosis of cystic echinococcosis

The patients with false immune diagnosis of hydatid disease were investigated for the humoural immune response to analyse the possible reasons and mechanism leading to false immune diagnosis. Two hundred and thirty‐nine patients with nature‐unknown cysts and 30 healthy controls were detected by immunological assays (four hydatid antigen‐based immunogold filtration assay and enzyme‐linked immune absorbent assay) and ultrasound. Sensitivity of and specificity of immunological assay and ultrasound were calculated, respectively. The serological diagnosis was compared with surgical pathology to screen the patients with false immune diagnosis for the immunoglobulin measurement and pathological analysis. The history and cyst characteristics were also reviewed. The results indicate the immunoglobulin has little influence on false immunodiagnosis. The false‐negative immunodiagnosis was caused by the cysts' inactive status while the false positive caused by previous rupture, antigen cross‐reaction. The clinical diagnosis of cystic echinococcosis requires a combination of immunodiagnosis and ultrasonography, which is the necessary complementary confirmation.     

Large solitary retroperitoneal echinococcal cyst： A rare case report

Echinococcal disease remains a problem within some endemic areas. Echinococcal cysts usually involve the liver and lungs, but any other organ can potentially be involved. Extrahepatic localization is reported in 14%-19% of all cases of abdominal hydatid disease. We report the case of a large echinococcal cyst localized in the lower pelvis. A 28-year-old woman was admitted to a surgical ward with lower abdominal pain and discomfort lasting for a month. Ultrasonography and computed tomography scanning revealed a large retroperitoneal cystic mass （9 cm × 4 cm） in contact with the left ovary and left ureter. There were no cysts in any other location. Serological tests were positive for Echinococcus. The patient was operated on and the entire cyst was excised intact. Histopathological results confirmed the diagnosis of echinococcosis. Antihelminthics were administered postoperatively and the patient was discharged after 6 d, and is now being closely followed up. Total cystectomy when possible represents the treatment of choice for large extrahepatic echinococcal cysts.     

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.     

Complications of extrahepatic echinococcosis：Fistulization of an adrenal hydatid cyst into the intestine

Echinococcal cysts are usually found in liver and lungs, but any other organ can potentially be involved. Extrahepatic disease due to hydatid cyst may develop in the abdominal and pelvic cavity, aside from in other less common locations, which may make both diagnosis and treatment more complex. We present a rare case of extrahepatic echinococcosis in a 70-year old patient with a 4-d history of dull abdominal pain, anemia within the transfusion range and fever. She underwent surgery for left renal hydatid cysts 30 years ago. After non operative treatment, imaging studies showed a calcified hydatid cyst in a retrogastric location communicating with a proximal jejunal loop. En-block resection of the mass together with the adrenal gland was performed including closure of the enteric fistula. Anatomic pathology confirmed the diagnosis of a calcified hydatid cyst of left adrenal origin. Surgery is the treatment of choice and most authors recommend removal of cyst and adrenal gland.     

Diagnosis and surgical treatment of complicated liver echinococcosis.

BACKGROUND/AIMS: Complicated liver echinococcosis considerably worsens the prognosis of the disease. In this study the treatment of patients with complicated disease was analyzed. METHODS: The records of 136 patients who had undergone surgery in our clinic during the last decade were evaluated. RESULTS: Among all complications, the most common were lesions of the bile ducts (88 patients) and suppuration of the cysts (77 patients). Twenty-nine cases had a combination of two complications. Surgery was based on the nature of complications, number and sizes of hydatid cysts and patients general condition. The surgical treatment of choice was echinococcectomy, with possible liquidation of the fibrous capsule cavity. In cases with complications such as suppuration, remaining bile fistulas, large cyst cavities or extrahepatic location, external drainage is obligatory. Post-operative complications occurred in 43 patients (31.6 %), 22.4 % of them being specific in nature. Postoperative mortality was 2.2 % (three patients). CONCLUSION: Timely diagnosis, appropriate investigation and well planned surgical techniques may improve the outcome of complicated liver echinococcosis.     

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。     

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.     

A Case of Sporadic <Emphasis Type="Italic">Echinococcus granulosus</Emphasis> Infection Originary from Southern Germany

Abstract A 67-year-old woman with cystic echinococcosis (CE) is presented. She had complained of upper abdominal discomfort due to large hepatic cysts. These cysts showed no typical infrastructure characteristic for CE and she had never left the rural areas of southern Germany. Most remarkably, this area is highly endemic for alveolar echinococcosis, caused by Echinococcus multilocularis, but only sporadic cases of CE have been described. Due to the discrepancy between positive Echinococcus serology, atypical morphology and residency in an area non-endemic for Echinococcus granulosus, diagnostic puncture was performed with albendazole coverage. Puncture was complicated by anaphylaxis, from which the patient recovered without sequelae. The diagnosis of CE was highly likely due to the combination of positive serology with post puncture anaphylaxis, increasing antibody titers and eosinophilia. Retrospectively, the cysts had initially corresponded to the WHO stage CE 1. The patient was treated with albendazole for 15 weeks. Under treatment, the parasitic membrane detached from the cyst wall, revealing characteristic morphology for CE, now corresponding to the WHO stage CE 3. The patient remained asymptomatic during follow-up visits.