胸部包虫病的CT诊断

目的:分析肺包虫病,尤其破裂、感染的肺包虫囊肿的CT征象及分型,估价CT诊断胸膜、纵隔、心包及膈肌等少见部位包虫囊肿的可靠性。方法:分析了21例由CT诊断并经手术、病理证实的胸部包虫病,其中肺包虫病16例,胸膜包虫病3例,纵隔心包及肺、纵隔和膈肌包虫病各1例。结果:根据本组资料统计,CT对胸部包虫病的定性诊断正确率为95％,定位诊断准确率为94％,破裂、感染肺包虫囊肿的诊断正确率为92％。结论:CT对破裂、感染的肺包虫囊肿和胸部少见部位包虫病的诊断价值很高。     

心脏、心包包虫囊肿的X线诊断

包虫病为我国广大牧区的常见病,但心脏包虫病却相当少见,国外医学文献统计一般低于人体包虫病的2％,国内除1例右心室包虫囊肿自发破裂致肺动脉梗塞猝死的尸检报告外,尚未见术前诊治本病的报导。心脏包虫囊肿还可破入心包,形成继发性心包包虫囊肿,两者之间的关系十分密切,而原发性心包包虫囊肿则相对少见。作者在包虫病的X线诊断工     

心脏及心包包虫病的外科治疗

1 资料与方法 心脏包虫囊肿的症状有非特异性,诊断这种疾病有一定难度.在世界上的一些地区棘球蚴病是一种严重的健康问题.但心脏受累较少见,早期诊断和及时手术干预是至关重要的.虽然棘球蚴病是在中国很普遍,但有关心脏包虫病手术治疗报道很少,新疆地区是我国包虫病高发区域之一,我们回顾治疗这种疾病的历史,从中总结经验及教训.     

包虫囊肿705例诊疗体会

目的 探讨包虫囊肿寄生虫病的诊疗经验。方法 回顾我院705例包虫病的诊断和治疗资料。结论 自1974～2005年期间就我院收治的705例包虫病患者均经手术治疗，取得良好效果。     

心脏包虫囊肿——二例外科治疗报告

新疆是我国包虫病严重流行区,但心脏包虫囊肿却属罕见。我院从1957年开院至1982年末,26年间心胸外科共收治胸内包虫囊肿724例,其中仅有4例累及心包及心肌。此4例中,1例系纵隔包虫囊肿累及心包,经手术切除部份心包而治愈;1例系肝包虫囊肿穿过膈肌累及心包,并发化脓性心包炎和心包填塞,经手术作心包引流而治愈;另     

包虫囊肿破裂所致过敏反应的差异分析与诊疗问题探讨

目的：探讨包虫囊肿破裂之过敏反应成因及诊断和治疗措施；方法：对132例包虫病患者中12例发生包虫囊肿破裂的过敏反应进行分析；结果：提前检测出包虫病人的反应性是预防过敏性休克死亡的关键。依其过敏反应的程度采取不同的治疗措施，疗效可靠；结论：个体差异是过敏反应强弱的主要因素；过敏反应多发生在有生命活动的包虫囊肿破裂后，包虫囊肿破裂的部侠不同，其反应程度有差异。     

肝包虫病诊疗体会

肝棘蚴球病(hepatic echinOcoccosis)又称肝包虫病(hepatic hydatido-sis),是流行于世界畜牧业发达地区常见的人畜共患性寄生虫病.目的 讨论肝包虫病诊疗体会.方法 根据患者临床表现与辅助检查结果进行诊断并治疗.结论 手术摘除是包虫病的主要治疗方法,药物治疗成为手术前、后的辅助治疗手段.手术方法有:包虫囊肿外囊完整剥除术、包虫囊肿穿刺内囊摘除术、包虫囊肿内囊完整摘除术和肝部分切除术.     

腹腔包虫囊肿34例临床分析

腹腔囊性包虫病包括生长在膜膜、大网膜、肠系膜及盆腔脏器上的原发或继发包虫囊肿。本文总结了我院1990～1997年间收治的34例腹腔囊性包虫病病例,报告如下。临床资料 1.一般资料:本组34例,男14例,女20例,年龄4个月～57岁,平均年龄28.4岁。原发性腹腔包虫病9例,继发25例。经手术治疗31例,余3例系药物治疗。 2.既往包虫病手术史:继发性包虫病患者既往平均行包虫囊肿手术1.7次(1～4次)。两次手术间     

包虫囊肿破裂在基层医院的诊治体会

探讨在条件有限的基层医院对包虫病囊肿破裂诊疗体会。急诊病人均在抗休克的同时行剖胸、腹探查术，术前的casoni试验和B超检查诊断。结果，术后复发率较高，并发症多。包虫囊肿破裂是危及病人生命的外科急诊，应早诊断，早手术。包虫病是人畜共患的疾病，在新疆农牧区常见，以肝包虫最多，因农牧区医疗条件有限，不能及时发现和治疗。本组病例均为巨大包虫囊肿或囊肿破裂后急诊就诊的病人，死亡率高，并发症多，现将诊治体会报告如下。     

人体眼眶包虫病13例临床分析

作者综合分析报告了人体眼眶包虫病13例。其占新疆地区全身包虫囊肿4276例的0.3％。结合临床实践系统地阐述了其流行病学、临床特点、诊断技术和治疗原则。并总结提出了诊断、治疗眼眶包虫病的要点与措施。     

Cyst and host tissue concentrations of mebendazole in patients undergoing surgery for hydatid disease

Mebendazole levels were assayed by high performance liquid chromatographic assay in plasma, host tissues, and hydatid material taken from four patients who underwent surgery for hydatid disease. The drug was absorbed and had penetrated both into the host and into the parasite material. The levels of the drug in viable hydatid cysts were much lower than those in dead cysts. The possibility of exclusion or detoxification of the drug by viable hydatid cysts is raised.     

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.     

Radiological appearances of hydatid disease in Wales

Thirty six patients with hydatid disease have been investigated in the Radiology Departments of Cardiff hospitals between June 1973 and June 1984; thirty two of these patients are likely to have acquired the disease in Wales. There were 16 hepatic cysts, 3 renal cysts, 2 cerebral cysts, 15 pulmonary cysts, 1 pleural cyst, 1 recurrent spinal cyst, and 1 cyst of the broad ligament. The radiological features are discussed. These patients emphasize the higher incidence of hydatid disease in Wales, compared with other regions of the United Kingdom, and the need to consider this diagnosis in Welsh patients from rural areas, who have large pulmonary opacities, or hepatic, renal, or cerebral cystic abnormalities.     

Surgical management of splenic echinococcal disease

Background

Infection of the spleen with echinococcus is a rare clinical entity. Because the diagnosis of a splenic infestation with echinococcus is sometimes delayed, large hydatid cysts or pseudotumors may develop, demanding a differential surgical approach to cure the disease.

Methods

In a retrospective study 10 patients out of 250 with abdominal echinococcosis (4%) were identified to have splenic infestation, either limited to the spleen (n = 4) or with synchronous involvement of the liver (n = 4), major omentum (n = 1), or the liver and lung (n = 1). Only one patient had alveolar echinococcosis whereas the others showed hydatid cysts of the spleen. Surgical therapy included splenectomy in 7 patients or partial cyst excision combined with omentoplasty in 3 patients. In case of liver involvement, pericystectomy was carried out simultaneously.

Results

There was no mortality. Postoperative complications were observed in 4 patients. Hospital stay and morbidity were not influenced when splenic procedures were combined with pericystectomies of the liver. Mean follow- up was 8.8 years and all of the patients are free of recurrence at this time.

Conclusions

Splenectomy should be the preferred treatment of hydatid cysts but partial cystectomy is suitable when the cysts are located at the margins of the spleen. Due to low morbidity rates, simultaneous treatment of splenic and liver hydatid cysts is recom mended.     

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.     

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。     

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.     

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     

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.

     

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。