脊柱包虫病的临床特点及诊断方法

目的探讨脊柱包虫病的临床特点,为诊断和治疗提供依据.方法回顾性分析1994年7月至2003年10月诊治的14例脊柱包虫病患者,男5例,女9例;年龄5～23岁,平均25.8岁.患者均有牧区生活史,病程为4～120个月,平均26.7个月.除行常规检查外所有患者均拍摄X线片,8例行CT扫描,13例行MR检查,8例行免疫血清学检查.病变多累及胸椎,占35.8%,其次为腰椎和腰骶椎,分别为21.4%和28.6%,颈椎较少见.根据Dew分类,包虫累及髓外硬膜内1例,椎管内硬膜外2例,脊椎7例,椎旁1例,其余3例累及硬膜外周围组织.所有患者均行手术治疗,并行组织病理学检查.结果脊柱包虫病的临床症状主要表现为病变部位的肿胀、疼痛或放射痛,后逐渐发展为脊髓神经损害.X线检查缺乏特征性,仅表现为局部不规则骨质破坏,可伴边缘硬化或钙化.CT主要表现为多个大小不等的囊状低密度缺损.MRI示病变呈多囊性生长,T1加权像上囊壁与囊内容物均呈低信号,T2加权像上囊壁呈低信号,囊内容物呈高信号,簇集呈“葡萄串样”;合并感染时,T1加权像和T2加权像信号均增强.8例行包虫三项检查的患者中7例阳性,其中3例接受包虫八项检查,均为阳性.组织病理学检查均为细粒棘球绦虫.结论MRI是诊断脊柱包虫病最敏感的方法,在确定病变部位和范围上具重要作用;CT和免疫血清学检查有助于包虫病的诊断和鉴别诊断;提高对该病的认识是防止误诊的关键.     

骨包虫病的诊断及治疗

目的 回顾性分析骨包虫病的临床表现和X线征象，探讨其诊断、鉴别诊断及治疗方法。方法 自1957年10月～2004年2月收治的骨包虫病患者37例，男16例，女21例。年龄14～58岁，平均29岁。病史0．5～12年，平均3．1年。发病部位：颈椎2例，肩胛骨1例，胸椎11例，肋骨2例，腰椎5例，髂骨1例，骶骨6例，耻骨1例，髋关节2例，股骨转子间1例，股骨上段2例，胫骨上段1例，肱骨头1例，桡骨上段1例。所有患者均采用手术治疗，以病灶清除为主，部分患者行自体骨、异体骨、人工骨或骨水泥填塞。术后口服阿苯达唑(片剂或原粉每日20mg／kg；阿苯达唑脂质体每日10mg／kg)3个月，预防复发。结果 25例行皮内Casoni试验，阳性2l例(84%）。4例行包虫病八项免疫试验，均为阳性。21例行MR检查，18例诊断为骨包虫病。24例获随访者，随访时间2～20年，平均3．6年。11例复发(45．83％)，其中胸椎4例，腰椎2例，骶骨4例，髋关节l例。6例四肢骨包虫病患者未见复发。24例脊柱骨包虫病患者中16例有神经系统损害，Frankel分级A级l例，B级3例，C级3例，D级9例，所有病例术后均有不同程度改善。结论 骨包虫病好发于躯干骨，尤其是脊柱。其影像学表现与结核、转移癌、骨巨细胞瘤、骨囊肿等相似，应注意鉴别。MRI有助于脊柱包虫病的诊断，血清学检查是诊断骨包虫病的主要方法；脊柱包虫病伴脊髓压迫采用手术治疗症状改善明显，但病灶不易清除彻底，容易复发。     

肝包虫病的诊断与治疗

肝包虫病(hydatid disease of liver)又称肝棘球蚴病(echinoeoccosis of liver),是犬绦虫(棘球绦虫)的囊状幼虫(棘球蚴)寄生在肝脏所致的一种寄生虫病。本病系由细粒棘球蚴,多房性棘球蚴或泡状棘球蚴所引起。肝包虫病有两种类型,一种是由细粒棘球蚴所引起的单房性包虫病(肝包虫囊肿),另一种是由多房性或泡状棘球蚴感染所致的泡状棘球蚴病(又称滤泡型肝包虫病)。     

脊柱包虫病2例报告

包虫病是通过粪口途径由动物传染给人的一种寄生虫病,病原体为细粒棘球绦虫。最易受累的脏器为肝和肺,肝肺包虫病几乎占到所有包虫病的90％。骨包虫病少见,仅占0．5％～4％,其中脊柱包虫病占到骨包虫病的50％。脊柱包虫病发病隐匿,不易早期诊断和治疗,容易引起误诊和漏诊。同时该病使脊柱周围重要的结构受到累及,手术难度大。2005年9月及2007年10月收治的2例胸椎包虫病病例,经手术及后续药物治疗取得较好的效果。     

巨大肾包虫病1例

病例资料患者女性 ,6 0岁 ,居住在牧区 ,因左腰背部酸胀伴左中上腹饱胀 2月入院。入院前在他院多次B超检查 ,均考虑为左肾下极巨大囊肿 ,因血压高 ,当地医疗条件差等原因转到我院。入院后查体 :血压 180 / 110mmHg(2 4 / 14 .7kPa) ,心率 80次 /min ,双肺未见异常 ,心界稍向左扩大 ,左中上腹部可触及巨大包块 ,下极达盆腔 ,包块可移动 ,有囊性感 ,表面光滑 ,界限清 ,叩呈浊音 ,左侧肋脊点、肋腰点压痛阳性。辅助检查 :彩超提示左肾下极探及 180mm× 15 0mm含液囊性占位 ,边缘呈双层壁 ,行卡松尼试验 1∶5 0及 1∶10 0比例均呈阳性 ,心电…     

包虫病手术治疗的进展（附21560例分析）

本文对新疆包虫病流行地区５８所县级以上医院４０年来经手术治疗的２１５６０例包虫病进行了临床分析，手术方式包括脏器部分或全部切除，包虫穿刺摘除，包虫完整摘除或经腹腔镜摘除术。对外囊空腔的处理方法有空腔闭锁，空腔敞开，网膜填充或闭式引流术。对术中囊内注药和术后口服杀虫剂辅助治疗等也进行了分衍。结果表明近十余年来包虫病手术治疗的效果提高显著。有的医院手术治疗近千例包虫病，无手术死亡及复发。     

包虫八项检查在骨包虫病诊断中的应用

目的 探讨包虫八项检查在骨包虫病诊断中的应用价值和骨包虫病的诊断策略.方法 对1999年10月至2008年9月因疑似骨包虫病而行包虫八项检查的36例患者进行回顾性研究.男19例,女17例;年龄10～67岁,平均35.9岁.采用金标渗滤法和酶联免疫法同时检测患者体内抗包虫囊液抗原(EsCF)、头节抗原(EgP)、囊液半纯化抗原B(EgB)、泡球蚴抗原(Em2)四个抗原的抗体水平,简称包虫八项检查.全部病例的最终诊断均经手术、病理学检查或穿刺活组织检查证实.对包虫八项检查结果进行ROC分析,确定最佳诊断界点(阈值),并计算灵敏度、特异度、Youden指数、阳性似然比、阴性似然比、阳性预报值、阴性预报值.结果 经病理学检查证实,36例患者中11例确诊为骨包虫病(胸椎包虫2例、肋骨包虫1例、腰椎包虫3例、骶骨包虫4例、髂骨包虫1例).包虫八项检查的灵敏度为90.91%,特异度为92.00%,Youden指数为0.8291,阳性似然比为11.3600,阴性似然比为0.0988,阳性预报值为83.33%,阴性预报值为95.83%.结论 血清学检查是骨包虫病鉴别诊断的重要手段.包虫八项检查诊断骨包虫病有较高的准确性.     

儿童胸部包虫病233例的临床分析

棘球蚴病又称包虫病，是细粒棘球绦虫的幼虫寄生于人体组织器官所致的疾病。儿童胸部包虫病的发病及诊治另具特点。我院自1957年6月至2004年12月收治胸部包虫病患儿233例，现将病例资料总结如下。     

腹腔镜治疗肝包虫的现状与展望

<正>肝棘球蚴病又称肝包虫病,是犬绦虫(棘球绦虫)的囊状幼虫(棘球蚴)寄生在肝脏所致的一种寄生虫病。是流行于畜牧区或半农半牧区的一种常见的寄生虫病,在我国多见于西北和西南地区。绝大数是细粒棘球蚴引起的单房性包虫病,     

Postoperative recurrence in hepatic hydatid disease

Recurrence of hepatic hydatid disease is still a serious problem in endemic areas like our country. In this study, we present the causes and management of recurrences after surgical therapy of the hepatic hydatid cysts. Hepatic hydatid cyst patients treated surgically and followed afterward at Istanbul University, Cerrahpasa Medical Faculty, Department of General Surgery between January 1998 and January 2003 were evaluated retrospectively. During this period, 172 primary patients with hepatic hydatid disease were attended to at our clinic. Morbidity and mortality rates for this series were 5.8% and 0.58%, respectively. Recurrence rate was 4.65% during the follow-up period of 60.5 months (range, 25-84 months). Primary causes of recurrence were thought to be unnoticed cysts with exophytic development due to inadequate incision and exposition and spreading of the disease during conservative operative interventions. It is concluded that selection of the proper incision allowing complete exposition, and performance of pericystectomy in solitary, peripherally located cysts prevent recurrence.     

脊髓海绵状血管瘤的诊治特点

目的：探讨脊髓海绵状血管瘤的诊治方法和特点，方法：1991－2001年治疗脊髓海绵状血管瘤22例，均进行MRI检查，16例行全脊髓血管造影，全组均经后背正中直切口显微手术治疗，结果：22例均为单发，1例术前未能明确诊断，术后证实为海绵状血管瘤，颈段8例，颈胸段6例，胸段4例，腰段2例，圆锥马尾部位2例。MR1显示团块状短T1长T2信号，中间由点条状长T1短T2信号分隔，形成桑葚状混杂信号团，周边绕以低信号团，尤以T2WI显著，随访3个月－2年，全组均未见复发，12例术后功能明显恢复。结论：MRI是脊髓海绵状血管瘤前最可靠的诊断方法。全脊髓血管造影可以排除其它脊髓血管畸形，显微手术切除是脊髓海绵状血管瘤的优选治疗方法，术中精细的显微操作是手术成功的关键。     

非特异性脊柱感染的诊断与治疗

目的:探讨非特异性脊柱感染的临床特征及治疗方法.方法:回顺性分析我科2006年9月～2012年2月收治的16例非特异性脊柱感染患者的临床资料,男6例,女10例,年龄23～66岁,平均53.5岁.腰椎8例,胸腰段6例,胸椎2例.患椎处剧痛14例,轻度胀痛2例,11例X线片显示患椎终板缘“鸟嘴样”增生,13例邻近终板侵蚀性破坏,边界模糊,周围硬化.所有患者均无成角畸形及明显神经损害.入院诊断为脊柱肿瘤1例,脊柱结核3例,疑似脊柱结核8例,脊柱感染4例.入院后诊断为“脊柱肿瘤”者直接行“肿瘤椎体”切除植骨内固定术,术后病理诊断为化脓性脊柱骨髓炎;其余15例患者治疗前均行病椎穿刺病理检查,诊断为非特异性脊柱感染,其中10例患者行保守治疗,4例患者因椎间失稳行前路病灶清除植骨、后路内固定术,1例因伴椎旁脓肿行单纯前路病灶清除植骨融合术.均应用敏感或广谱抗生素,手术治疗患者应用2～3周,保守治疗患者应用3～6周.结果:所有患者随访3～18个月,平均12个月.10例保守治疗患者中,6例痊愈;4例遗留腰背部僵硬感,行腰背肌理疗及功能锻炼后均缓解.6例手术患者中,1例误诊为脊柱肿瘤患者术后1.5年X线片显示植骨端骨吸收,患者有腰背部僵硬感,暂予观察;其余5例患者随访时植骨均骨性融合,2例遗留不同程度腰背部僵硬,但均不影响生活.所有患者随访期间无复发.结论:脊柱非特异性感染容易误诊,治疗前行穿刺病理检查可早期确诊,多数患者经保守治疗可治愈,对影响脊柱稳定性者应选择手术治疗.     

Cardiac involvement of hydatid disease

Objectives|Echinococcosis is a serious health issue occurring in some geographical region of the world. Cardiac involvement is rare and early diagnosis and prompt surgical intervention are critical.Subjects and Methods: Six patients with cardiac hydatid cysts underwent surgical treatment in our institution between April, 1996 and March, 2002. Five of the patients were female and one was male. Average age was 40±5 years with a range of 19 to 72 years. Cysts were located in the right ventricular outflow tract in two patients, the left ventricular outflow tract in one, the right atrial in one, the right ventricular in one and the right atrioventricular groove in one. Five patients were operated on using standard cardiopulmonary bypass techniques, and one was operated on without cardiopulmonary bypass.Results: In the perioperative and the early postoperative period, no cardiac problems was observed. On control echocardiography, a ventricular septal defect was detected in one patient in the late postoperative period. The ventricular septal defect was repaired using standard cardiopulmonary bypass and was closed with a teflon patch. Patients were followed up for a mean period of 3.4±2.5 years. No mortality or recurrence was observed during the follow-up period.Conclusions: When hydatid cyst is diagnosed, the possibility of cardiac involvement should also be investigated. The treatment of cardiac hydatid cyst is surgical extraction of the cyst.     

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目的 总结19例肝泡状球蚴病致梗阻性黄疸，行超高位胆肠吻合术的治疗经验。方法 肝泡状球蚴病根治性切除12例（右半肝6例，左半肝4例，右三叶2例）。空肠与右肝管Roux-Y吻合4例。空肠与左肝管Roux-Y吻合8例，中肝叶姑息性切除7例，行空肠间置胆肠吻合。结果 18例泡型黄疸病人痊愈出院，1例术后发生胆肠瘘，死于肝肾综合征。16例坚持口服吡喹和甲苯咪唑。结论 泡型黄疸经泡肝根治性或姑息性切除，超高位胆肠吻合可改善肝功能，延长病人生存期限。     

硬脊膜内脂肪瘤的诊断与治疗

目的 :探讨硬脊膜内脂肪瘤的诊断和治疗方法。方法 :分析 8例硬脊膜内脂肪瘤患者的临床特点、神经放射学资料。经背正中切口入路用显微外科技术切除肿瘤。结果 :8例中 ,3例予次全切除 ,5例予部分切除。术后症状明显好转 3例 ,部分好转 2例 ,无变化 2例 ,加重 1例。结论 :CT和MRI有助于确诊本病 ,症状明显者应行显微外科减压。     

Management of hydatid disease of the liver—10 years'' experience in a non-endemic area

The incidence of hydatid disease of the liver caused byEchinococcus granulosus in Austria, a nonendemic region in central Europe, is documented over a 10-year period. Since 1984, 28 patients (24 women, 4 men) with hydatid disease of the liver have undergone surgery in our department. A definitive diagnosis was established by combining serological tests (an enzyme-linked immunosorbent assay withEchinococcus multilocularis antigen and an indirect hemagglutination assay withEchinococcus granulosus antigen) and abdominal imaging (computed tomography scan and ultrasonography). Twenty-four patients (85.7%) had uncomplicated echinococcosis; in most of them (16) total closed pericystectomy was done. Four patients (14.3%) had complicated echinococcosis, suffering from intrabiliary rupture and spontaneous perforation into the peritoneal cavity, and in two of these patients (7.1%) pyogenic transformation, one with abscess perforation, occurred. Postoperative complications were significantly more common in patients with complicated echinococcosis and included two bile leaks (necessitating prolonged tube drainage), pleural effusion, atelectasis, and wound infection. One recurrence of hydatid infection due to previous spontaneous perforation required reoperation 4 years after the primary event. The low recurrence rate of uncomplicated echinococcosis (0%) over a mean period of 5.6 years and of 3.6% when peritoneal echinococcosis was included may be the result of the radical surgical technique employed.     

Our experience in eight cases with urinary hydatid disease: A series of 372 cases held in nine different clinics

OBJECTIVES: Hydatid disease, a parasitic infestation caused by the larval stage of the cestode Echinococcus granulosus, is diagnosed commonly in the east and south-east regions of Turkey. The aim of this study is to emphasize the relatively frequent occurrences of echinococcosis in our region, and to discuss therapeutic options and treatment results according to current literature. METHODS: A retrospective 10-year review of nine different clinics' records of the Research Hospital of the Medical School of Yüzüncü Yil University revealed 372 hydatid disease cases that were localized in various organs and treated surgically (271 cases) or drained percutaneously (99 cases). Hydatid disease was diagnosed by ultrasonography (US) and computed tomography scans (CT) and confirmed histopathologically. RESULTS: The involved organ was lung in 203 cases (131 adults, 72 children), liver in 150, spleen in 9, brain in 2, kidneys in 7 cases and the retrovesical area in 1 case. The urogenital system is involved at a rate of 2.15%. Two hundred and seventy-one cases were treated surgically and 99 percutaneously. Two cases with renal hydatid cyst refused the surgical procedure (one had a solitary kidney with hydatid cyst). Albendazole was administered to 192 patients; 93 patients had open surgical procedure and 99 patients underwent percutaneous procedure. Cysts were excised totally in the open surgical procedure; however, involved kidneys were removed totally (four cases) except one. Cystectomy and omentoplasty was performed in one case. Complications were as follows: in six cases, cystic material was spilled into the bronchial cavity during the dissection and a renal hydatid cyst ruptured and spilled retroperitoneally. CONCLUSION: Hydatid disease is a serious health problem in Turkey. The mainly affected organs are liver and lung. It can be treated surgical or by percutaneous aspiration.