肾包虫囊肿的CT诊断(附3例报告)

本文报告经手术证实的3例肾包虫囊肿的CT表现。其特征性表现是:(1)卵圆形或圆形水样密度囊肿。(2)母囊内有子囊。(3)囊膜剥离征象。(4)囊壁钙化。并讨论了本病的破裂感染和与先天性肾囊肿的鉴别诊断。     

心脏包虫病的诊断及治疗

作者总结了6例心脏包虫病人的诊断和治疗,其中5例为心肌和心包包虫囊肿,1例为右心房内包虫囊肿。提出因心脏包虫病无特征性临床表现,诊断需借助超声技术、放射学、免疫学检查等。手术治疗可视囊肿所在部位采用体外循环或一般开胸手术行内囊摘除术,并在术前术后给于药物治疗以提高手术的安全性和疗效。     

Current management of liver hydatid cysts: results of a 10-year study

During the 10-year period July 1977 to June 1987, 23 patients were referred to one surgical department with hepatic hydatid cysts. Accurate diagnosis in all but one case was possible by hydatid serology (hydatid immunoelectrophoresis and enzyme-linked immunosorbent assay), and ultrasonography or computed tomography which showed the presence of daughter cysts. Endoscopic retrograde cholangiography demonstrated the presence of hepatic-duct hydatid cysts in one case. The probable source of the hydatid infection was identified in all 23 cases. The surgical management was standardized and included the use of a suction cone to prevent spillage; the closure of biliary communications under vision; 0.5% silver nitrate solution as the scolicidal agent; primary closure of the residual cavity without drainage; omentoplasty for infected cysts; and bile-duct exploration and operative choledochoscopy for choledochal hydatid cysts. Two hepatic wedge resections were performed for hydatid cysts in a Riedel's lobe, but formal liver resection, in which normal liver tissue was sacrificed, was not necessary. There was no mortality and there were no postsurgical hepatobiliary complications such as biliary fistulas, biliary sepsis or jaundice. Three (13%) recurrences were recognized; all three recurrences occurred about five years after the removal of hydatid cysts with numerous daughter cysts, which were located in multiple cavities in both lobes of the liver. Postsurgical surveillance for several years by annual clinical review, hydatid immunoelectrophoresis testing and ultrasonography is recommended.     

Epidemiological study of hydatidosis in the dromedaries (Camelus dromedarius) of different regions of Iran

ObjectiveTo determine the prevalence of hydatidosis in dromedaries.Methods438 dromedaries were examined in five regions of Iran from 20 March, 2010 to 19 March, 2011. The relationship between host age and the mean number of hydatid cysts, and prevalence and fertility rates was analyzed using chi-square test.ResultsOne hundred and thirty five out of 438 (30.82%) camels harboured hydatid cysts of Echinococcus granulosus. Number of cysts was 700 with 72.5% lung cyst. The highest rate of infection was that 54 (40%) of camels was found in the Khorasan Razavi region (in the north-east part of Iran) while the lowest 6 (4.4%) of camels was found in Semnan province. Infection was higher in >15 years age group. The most commonly infected organs were lungs (72.5%) followed by liver (12.6%). Both liver and lungs together constituted 14.8% of infection. A comparison found that hydatid cysts of liver had a higher fertility rate (32.57%) than that of lung (19%); while most of cysts of lung were calcified (24.42%). The mean number of protoscoleces per mL in the lung fertile cysts was higher than that of liver cysts. Fertile or sterile might be due to the different species or genotypes. The mean number of cysts in infected liver and lungs was 1–5 cysts. The intensity of infection increased with age.ConclusionsThe results of current study can make a background data for implementing hydatid control programs and warrant the importance of camel in public health.     

高强度聚焦超声波对棘球蚴的杀伤效果

目的 探索高强度聚焦超声波(high intensity focused ultrasound,HIFU)杀伤棘球蚴(Echinococcus cysts)的效果.方法 采集感染棘球蚴的新鲜羊肝,选取囊壁较薄、触摸弹性较好、直径<50 mm的棘球蚴囊25个,采用随机区组设计的方法 分为5组,每组5个.实验组分别用100、150、200、250 W声功率HIFU对棘球蚴囊进行沿着囊壁多层面的环形照射,覆盖棘球蚴囊囊壁,层面间距为5 mm,每个层而沿囊壁环形扫描1遍,环形扫描速度为3 mm/s,扫描1次,照射时间2～10 min;对照组用普通超声照射2 min.以原头蚴的死亡率作为效应指标,同时检测囊液中乳酸脱氢酶、碱性磷酸酶活性.结果 HIFU照射后棘球蚴的原头蚴急性死亡率显著升高(F=38.00,P<0.01),囊液内的乳酸脱氧酶活性显著升高(F=14.75,P<0.01),碱性磷酸酶活性显著升高(F=12.00,P<0.01).结论 HIFU沿棘球蚴囊壁多层面环形照射的方法 对棘球蚴有损伤的效果.     

二十五味铜灰散治疗小鼠继发性棘球蚴病的实验研究

目的　通过应用藏药二十五味铜灰散治疗小鼠继发性棘球蚴病的疗效观察 ,探讨藏药治疗棘球蚴病的免疫机理 ,为临床应用药物治疗棘球蚴病奠定理论基础。方法　小鼠被随机分成 4组 (藏药两种浓度组、对照组和阿苯达唑组 ) ,给予药物治疗 90天后 ,解剖小鼠 ,检测各小鼠棘球蚴囊的湿重及血清IgE、IL - 2、IL - 1 0的含量 ;并对棘球蚴囊行病理组织学和超微结构观察。结果　从病理组织学切片上可以看到 ,棘球蚴囊壁有明显的损伤。超微结构观察发现 ,角皮层薄厚不均匀 ;皮层区微毛变短、稀疏、模糊不清 ;细胞核固缩、核间隙增大、核碎裂 ;用药组小鼠血清IL - 2、IgE含量与对照组相比有显著性差异 (P <0 .0 5 ) ,用药组IL - 1 0的含量与对照组比无明显差异 (P >0 .0 5 )。结论　藏药二十五味铜灰散对小鼠棘球蚴有比较好的治疗作用     

Clinical Experience in Treating Intracranial Hydatid Cysts: Report of 97 Cases

Background: Echinococcosis is still endemic in many countries, including China, especially in its north-west part, but the world literature which describes the Chinese experience in treating the cerebral hydatid cyst is still lacking. In this report, clinical manifestations, radiological features and surgical outcomes of 97 patients with intracranial hydatid cysts were analyzed and the transmission pattern, preoperative diagnosis, treatment methods and long-term outcome were discussed. Methods: We retrospectively reviewed the clinical features ( neurological symptoms and signs), radiological manifestations( X-ray, CT, MRI) and surgical outcome of 97 patients with intracranial hydatid cysts whom received surgical treatment at the neurosurgical department of Xinjiang Medical University between the year 1985 to 2010.We have followed up the patients via sending questionnaire or telephone contact. Clinical outcome was evaluated by using Karnofsky Performance Scale Index (KPSI). Results: Headache and vomiting were the most common initial symptoms in our patients. Neurological deficits caused by the mass effect of the cysts were seen in 82 cases, which include hemiparesis, visual deficit, diplopia and aphasia. Epilepsy was occurred in five patients with hemispheric hydatid cysts. On X-Ray, significant bone erosion was seen in only two cases with epidural hydatid cysts. Round shaped and thin walled homogeneous low-density cystic lesion without surrounding edema and enhancement were the main findings on CT in 95 patients with intraparenchymal hydatid cysts, while two cases with epidural hydatid cysts were manifested as a heterodensity lesions. On MRI, Hydatid cyst was manifested as a round low signal lesion in T1-Weighted images and high signal lesion in T2-weighted images, without enhancement after contrast media injection, while the two cases with epidural cysts were manifested as mixed signal masses. Surgical removal of cyst was performed in all cases. Total removal was achieved in 93 cases without rupturing the cyst wall. Only two cysts ruptured during the dissection, resulted in two surgery related mortality. There was no other additional neurological deficit caused directly by surgery. Patient outcome was 97.2% with Karnofsky Performance Scale score 80 to 90. Conclusion: Intracranial hydatid cyst is still a main cause of increased intracranial pressure among the patients in endemic areas. CT and MRI have been proven to be the best diagnostic modality for diagnosing intracranial hydatid cyst. Surgery is the treatment of choice for intracranial hydatid cyst whenever possible.     

Treatment of intracranial hydatid cysts

Background  Echinococcosis is still endemic in many countries, including China, where it is especially prevalent in the northwest. The aim of this study was to enrich the international literature about the treatment of intracranial hydatid cysts.

Methods  We retrospectively reviewed the clinical features, radiological manifestations, and surgical outcome of 97 patients with intracranial hydatid cysts, who received surgical treatment at the Neurosurgical Department of First Affiliated Hospital of Xinjiang Medical University from 1985 to 2010 and followed up the patient via sending a questionnaire or telephone contact. Clinical outcome was evaluated using the Karnofsky Performance Scale Index.

Results  Headache and vomiting were the most common initial symptoms in our patients. Neurological deficits caused by the mass effect of the cysts were seen in 82 cases. On the X-ray, significant bone erosion was seen in only two cases with epidural hydatid cysts. Round-shaped and thin-walled homogeneous low-density cystic lesions without surrounding edema and enhancement were the main findings on computerized tomography (CT) in 95 patients with intraparenchymal hydatid cysts, while two cases with epidural hydatid cysts presented as a heterodensity lesions. On magnetic resonance imaging (MRI), hydatid cyst presented as a round-shaped low signal lesion in T1-weighted images and high signal lesion in T2-weighted images, without enhancement after contrast media injection, while the two cases with epidural cysts presented as mixed signal masses. Surgical removal of cyst was performed in all cases. Total removal was achieved in 93 cases without rupturing the cyst wall. Only two cysts ruptured during the dissection, resulting in two surgery-related mortalities. There was no other additional neurological deficit caused directly by surgery. In 97.2% of the patients, the Karnofsky Performance Scale score was 80 to 90 at the last follow-up.

Conclusions  Intracranial hydatid cyst is still a main cause of increased intracranial pressure among the patients in endemic areas for echinococcosis. CT and MRI are the best diagnostic methods and surgery is the treatment of choice for intracranial hydatid cysts.

     

Pericyst may be a new pharmacological and therapeutic target for hydatid disease

Background  Most hydatid cysts with calcified walls are biologically and clinically silent and inactive. Transforming growth factor-beta 1 (TGF-β1) plays a critical role in the calcification process of cells. The aim of this study was to assess the effect of modulating TGF-β1 signaling on the calcification of hydatid cysts.

Methods  Pericyst cells isolated from hepatic hydatid cysts were cultured with osteogenic media. These cells were assessed for alkaline phosphatase activity and mineralization capacity using Alizarin Red staining. Cells were also treated with recombinant human TGF-β1 and TGF-β inhibitor, and the expression profiles of osteoblast markers (RUNX2, osterix, and osteocalcin) were analyzed using Western blotting. The effects of inhibiting TGF-β1 signaling on calcification of pericyst walls were assessed using different doses of TGF-β inhibitor for 7 weeks in a preclinical disease model of liver cystic echinococcosis.

Results  Cells within the pericyst displayed high levels of alkaline phosphatase activity and mineralized nodule formation, as induced by osteogenic media. These activities, as well as expression profiles of osteoblast markers (RUNX2, osterix, and osteocalcin) could be inhibited by addition of recombinant human TGF-β1 (rhTGF-β1) and enhanced by TGF-β inhibitor. In the animal model of cystic echinococcosis, inhibition of TGF-β1 signaling increased calcification of the pericyst wall, which was associated with decreased cyst load index and lower viability of protoscoleces.

Conclusions  Cells within the pericysts adopt an osteoblast-like phenotype and have osteogenic potential. Inhibition of TGF-β1 signaling increases hydatid cyst calcification. Pharmacological modulation of calcification in pericysts may be a new therapeutic target in the treatment of hydatid disease.

     

Caroli's disease misdiagnosed as hydatid liver cysts

A 27 year old woman who presented with upper abdominal pain was found on ultrasonography to have multiple liver cysts consistent with hydatid disease. Three years previously she had undergone evacuation of multiple infected liver cysts thought to be due to hydatid disease. Computed tomographic scanning supported the diagnosis of hydatid disease affecting the right lobe of the liver. At laparotomy the right lobe contained multiple cysts which were removed by right lobectomy. Histology revealed congenital dilatation of the intrahepatic bile ducts with fibrosis (Caroli's disease) but no evidence of hydatid disease.     

应用腹腔镜治疗肝包虫病临床经验与体会（附120例报告）

目的 总结腹腔镜治疗肝包虫病的临床经验。方法 对120例腹腔镜肝包虫内囊摘除术患者进行回顾性的分析。结果 手术均获成功，未发生肝包虫囊液溢出、过敏性休克，无手术死亡，4例术后复发(非原发部位)，8例术后胆漏，8例残腔积液，1例术后出血，均获治愈。结论 腹腔镜肝包虫内囊摘除术是治疗肝包虫病安全、有效的微创方法。     

A case of disseminated hydatidosis

A young lady initially found to have hydatid cysts in the lung only, subsequently within a very short period was found to develop cysts in the liver. Soon after, she developed cysts in the subcutaneous tissue over the anterolateral chest wall, which, on investigation, revealed hepatic cysts herniating through the chest wall defects caused by previous operations. The unique features of this case include the degree of dissemination, the multiplicity of sites and the peculiar nature of herniation of the hepatic cysts into the parietes.     

泡球蚴组织及囊液同工酶初步分析

应用 PAGE 法对多房棘球绦虫的泡球蚴囊液、全囊、原头蚴及囊壁组织的乳酸脱氢酶(LDH)、酯酶(EST)和酸性磷酸酶(AP)的同工酶进行了分析.结果 LDH 同工酶仅囊液与全囊各出现4条酶带.EST 同工酶全囊、囊液、原头蚴和囊壁分别出现14、17、3和13条酶带;而 AP 同工酶4种样品的酶带则分别是2、4、1和1条.3种同工酶的酶带数均以囊液样本为多且染色深,提示囊液可能是泡球蚴物质代谢的一个重要场所.     

人体细粒棘球蚴接种小鼠体早期发育观察

人体肺或肝内棘球蚴的生发囊或原头蚴接种杂交小白鼠腹腔,最初可见游离的原头蚴周围有大量中性细胞及少数嗜酸性细胞,原头蚴结构模糊,生发囊外有明显的细胞反应带。如系存活的原头蚴其内部结构多集聚于一处,并有少数顶突钩,原头蚴可向不同方向形成有角质层外被的突起,突起可脱离原头蚴,形成有角质层的新个体,但未见内侧有生发层存在。     

几种化疗药物杀原头蚴的效果比较

离体试验0.062～0.25％新洁尔灭,0.125～O.25％醋酸,O.1～O.2％安替福民和0.05～0.2％麝香草酚溶液均具有较强的杀原头蚴作用。均在5～10分钟内可达到100％杀死原头蚴的效果,作用迅速可靠,毒性小。原头蚴与药液接触后可在2～3分钟内出现皮层起泡、起刺、皮层分离、溶解及虫体发暗、钙粒减少等形态结构变化,原头蚴经药液处理10分钟后,给小白鼠腹腔接种,均未发育成棘球蚴。原头蚴经10％甲醛和3％双氧水溶液处理10分钟,死亡率(染色法的着色率)分别为5.2％和O,用5％甲醛和1.5％双氧水溶液处理原头蚴10分钟后接种小鼠腹腔其感染率分别为16.6％和22.2％。     

应用腹腔镜治疗肝包虫病临床经验与体会(附120例报告)

目的总结腹腔镜治疗肝包虫病的临床经验。方法对120例腹腔镜肝包虫内囊摘除术患者进行回顾性的分析。结果手术均获成功,未发生肝包虫囊液溢出、过敏性休克,无手术死亡,4例术后复发(非原发部位),8例术后胆漏,8例残腔积液,1例术后出血,均获治愈。结论腹腔镜肝包虫内囊摘除术是治疗肝包虫病安全、有效的微创方法。     

Echinococcosis (Hydatid Disease): Review and Report of a Case of Secondary Echinococcosis

Echinococcosis is a disease caused by the larval form of Echinococcus granulosus. The adult worm lives parasitically in the intestine of the definitive host, the dog, wolf and other wild carnivores. The ova, which are passed in the feces, are ingested by grazing animals. The intestinal juices free the ovum from its cuticle and, having entered a capillary, it is carried by the blood stream to the liver or lung, where it develops into a hydatid cyst. Man becomes infected by ingesting contaminated vegetables or drinking contaminated water.

In a mature hydatid cyst there may be thousands of scolices and each one of these, if released from the hydatid cyst, may form a new cyst if it is planted in a suitable environment. Hydatid cysts are most commonly found in the liver and the lung, but may occur in other organs.

A hepatic cyst may rupture into the peritoneal cavity and produce a hydatidoperitoneum. A pulmonary cyst frequently ruptures into a bronchus and is thus evacuated.

The disease is of world-wide distribution. In Canada most of the cases of this disease have occurred among Indians and Eskimos. It is now known that a sylvatic cycle has been established in North America and that it serves as a source of infection of the dog and man.

The patient reported herein had spontaneous rupture of a hepatic hydatid cyst, with subsequent development of secondary peritoneal echinococcosis. Repeated laparotomies had to be performed to relieve pressure on or obstruction of various organs. The patient made an uneventful recovery and is again usefully employed. No effective medical treatment for this disease is available.

     

肝包虫外膜内完整摘除术适应症初探

目的 :探讨“肝包虫外膜内完整摘除术”的手术适应症。方法 :对我院同期收治的 6 7例肝包虫病患者手术情况进行回顾性分析 ,探讨不同情况的肝包虫囊肿使用该手术的可行性、安全性。结果 :6 2例成功实施了“肝包虫外膜内完整摘除术” ,同期 5例失败。结论 :在开展该术式初期 ,其适应症的提出应当相对保守。较为适合的适应症应为 :①患者一般情况良好 ;②肝脏单发或多发细粒棘球蚴病 ;③外囊与肝组织或肝门主要血管或胆管存在可分离间隙 ;④未破入较大胆管 ;⑤患侧肝脏可充分游离     

Diagnosis and management of hepatic hydatidosis complicated with biliary fistula.

A total of 1,204 patients with liver hydatidosis were treated by operations in our hospital from 1953 to 1990. Of these 74 had biliary fistulae. Growth of echinococcus cyst causes displacement, distortion and stenosis of the hepatic ductules with impaired bile drainage. Biliary effusion may occur between the endo- and ecto-cyst walls. Long term compression renders the hepatic ductule atrophic, and liable to rupture, forming a hydatid cyst-biliary fistula. The hydatid cyst can rupture into the biliary tract, and cyst fluid escapes into the biliary tract with daughter cysts discharged into the common bile duct, causing biliary colic, obstructive jaundice and possibly liver abscess. For acute obstructive and suppurative cholangitis, drainage of purulent bile and daughter cysts and management of the infected hydatid cyst are indicated. After removal of the echinococcus cyst, the fistulous opening on the hepatic duct must be sutured, but a small biliary fistula may be left alone. According to the thickness of the ectocyst wall, size of the cavity, severity of the infection, and degree of bile leakage, one of the following operative procedures for obliteration of the residual cavity can be selected: (1) closure by inversion suture of ectocyst; (2) omental or muscle flap obliteration; (3) closed catheter drainage.

     

骨桥蛋白在肝包虫动物模型外囊壁中的表达

目的:观察动物模型肝包虫囊壁情况,研究骨桥蛋白(Osteopontin,OPN)在小鼠肝细粒棘球蚴外囊壁中的分布特征及表达相关因素,并探讨其意义.方法:肝包虫动物模型的制作、HE染色观察、免疫组化观察53例小鼠肝细粒棘球蚴外囊壁中OPN及巨噬细胞的表达与分布.结果:HE染色外囊的着色明显较周围巨噬细胞带深,不存在渐变的过程;83%肝细粒棘球蚴外囊壁中有不同程度OPN表达,且集中分布于肝包虫纤维囊壁(外囊),与外侧巨噬细胞带比较有显著差异(P＜0.01).结论:在动物模型上证明了外囊与肝实质间存在可分离间隙,OPN主要分布在肝细粒棘球蚴外囊,并在其形成过程中起重要作用.