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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] 相似文献
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1974年 7月~ 2 0 0 3年 5月本院共收治肝细粒棘球蚴病 (又称肝包虫病 ) 3 12 6例 ,作者针对肝棘球蚴囊肿的结构类型 ,采取不同的手术方式 ,取得了较好的效果。报告如下。1 临床资料1.1 一般情况 本组 3 12 6例 ,男性 1865例 ,女性 12 61例 ,年龄 6~ 77岁 ,平均 41.5岁。1.2 结构类型 单发单子囊型 172 6例 (5 5 .2 1% ) ,单发多子囊型 480例 (15 .3 6% ) ,多发单子囊型 3 83例 (12 .2 5 % ) ,多发多子囊型 165例 (5 .2 8% ) ,多间隔多房多子囊型 3 72例 (11.90% )。1.3 部位 肝棘球蚴囊肿位于肝右叶 2 2 17例 (70 .92 % ) ,肝左叶 … 相似文献
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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。 相似文献
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<正>2003-2008年甘肃省金昌市第一人民医院普外科收治疑似精索细粒棘球蚴病2例,现报告如下。1病例资料病例1,男,42岁,牧民,裕固族,甘肃省肃南县人。因腹 相似文献
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患者女性,31岁,云南省曲靖市沾益县德泽乡人。3年前B超检查肝左外叶囊性占位性病变,怀疑肝囊肿。2003年3月B超复查囊肿明显增大。2004年4月彩色B超查见肝左外叶约(8.4×7.6×6.9)cm的囊性无回声区,边界清楚,透声良好,诊断为肝囊肿。当天局部麻醉,行B超引导下肝囊肿穿刺,抽出的无色透明液体(277ml)中见许多淡黄色小颗粒状物。75%乙醇蛋白定性试验,2次均阴性。抽出液分别送本院检验科及昆明医学院寄生虫学教研室检查。送检液体无色透明,其中悬浮许多细粒棘球绦虫(Echinococcus granulosus)的原头蚴及囊壁碎片,确诊为肝细粒棘球蚴病,行肝棘球蚴病手术切除治疗。 相似文献
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人源细粒棘球蚴染色体测定 总被引:5,自引:0,他引:5
陆家海 《中国人兽共患病杂志》1998,14(5):73-74,96
为鉴定棘球地细胞系及棘球绦虫的遗传分类提供依据,本实验测定了人源细粒棘球拗染色体。从外科手术的包虫病人体内获取棘球蚴原头节和生发层细胞,按染色体的常规制备方法并加以改进,制备染色体标本。通过对141个分裂像的观察分析,结果表明细粒棘球蚴染色体组的染色体数在5~20条之间,14~18条占明显优势。每一核型有一对染色体呈大棒状,似呈中间或亚中着丝粒,其余染色体呈方点状,似呈端着丝粒。本实验建立了适合棘球蚴染色体制备的方法,在国内首次测定了人源细粒棘球蚴染色体。 相似文献
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肝细粒棘球蚴病的免疫研究进展 总被引:2,自引:0,他引:2
棘球蚴感染过程中,宿主的免疫应答机制十分复杂,免疫保护和免疫损伤并存。研究肝细粒棘球蚴免疫机制,将有助于阐明肝棘球蚴病的病理机制及调整恢复机体的正常免疫功能,为预防和治疗肝棘球蚴病提供一定的依据。 相似文献
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李荣荣 《中国寄生虫学与寄生虫病杂志》2002,20(4):208-208
卵巢包虫病较为少见。我们发现 1例无肝、肺和腹腔包虫囊肿的卵巢细粒棘球蚴病患者 ,报告如下。患者女性 ,4 7岁 ,回族 ,农民。生活于农牧区 ,与牛、羊、犬有密切接触史。下腹部发现包块半年 ,疼痛一月余。作者单位 :新疆尼勒克县人民医院 ,尼勒克 83570 0 2 0 0 1年 11月 7日来院就诊 ,以“腹腔包块 ,性质待查”入院。查体 :心、肺、肝、脾均未见明显异常。B超示下腹部混合性占位。 2 0 0 1年 11月 13日行剖腹探查术。术中见左侧卵巢囊性肿物 ,15 cm× 10 cm× 8cm,内见多个乳白色小囊泡 ,病理诊断 :卵巢细粒棘球蚴病。卵巢细粒棘球蚴… 相似文献
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肝泡型棘球蚴病是由多房棘球绦虫幼虫寄生于宿主体内所引起的一种慢性人兽共患寄生虫病。根治性手术切除是肝泡型棘球蚴病首选的治疗方法。近年来,随着一些微创外科治疗方法在外科系统各领域的普及,微创外科技术逐渐开始应用于肝泡型棘球蚴病的临床治疗。本文就肝泡型棘球蚴病的微创外科治疗现状及进展进行综述。 相似文献
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Yoshie Une Naoki Sato Junichi Uchino 《Journal of hepato-biliary-pancreatic sciences》1996,3(2):142-148
Cure of alveolar echinococcosis of the liver can be achieved by complete removal of the lesion, this being possible only by hepatic resection. Nevertheless, 25% of patients have unresectable lesions. The purpose of this work was to analyze the clinical sequelae and prognosis of patients after curative and palliative surgery for alveolar echinococcosis of the liver. The 10-year survival rate of patients who underwent hepatectomy with complete resection of the lesion was 100% compared with 63% in the patients who had hepatectomy with incomplete resection of the lesion. Thirty-seven patients with unresectable hepatic echinococcosis were divided into two groups; the 10 patients in group A underwent only exploratory laparotomy, and the 27 patients in group B had palliative surgery. In group B, marsupialization or cyst drainage was performed in 17 patients, biliary drainage in 6 patients, and biliary reconstruction in 4 patients. The outcome after surgery was compared in the two groups. The 5-year survival of the patients in group A was 30%, and all patients died of liver failure within 7 years. The survival rates of patients in group B were 60% at 5 years, 55% at 10 years, and 35% at 15 years. Complete removal of the lesion by hepatectomy results in satisfactory prognosis. Palliative surgery may offer improvement in terms of survival and quality of life when complete removal is not possible. 相似文献
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Gurkan Ozturk Kamil Yalcin Polat Mehmet Ilhan Yildirgan Bulent Aydinli Sabri Selcuk Atamanalp Unal Aydin 《Journal of gastroenterology and hepatology》2009,24(8):1365-1369
Background and Aim: Hepatic alveolar echinococcosis (HAE) involves both the vascular and biliary structures of the liver. Endoscopic retrograde cholangiopancreatography (ERCP) is said to be an alternative for the diagnosis and treatment of biliary complications of HAE. We present here our experience with ERCP in HAE.
Methods: We followed 13 patients who underwent ERCP for the treatment of biliary complications of HAE in the endoscopy unit of our clinic at Ataturk University School of Medicine, Erzurum between January 2002 and June 2008.
Results: Eight men and five women were followed up. Mean age was 43.2 (24–64 years). All patients had non-resectable HAE. Indications for ERCP were biliary fistula in seven patients, obstructive jaundice in five patients and cholangitis in one patient. Endoscopic sphincterotomy (ES) was carried out in 12 patients, and in one patient with biliary leakage, a stent was inserted into the right hepatic branch. ERCP findings were dilated common bile duct, irregular narrowing and distortion of the common bile duct and common hepatic duct, communication with the cystic cavity or biliocutaneous fistula and complete disappearance of the biliary tree above the level of the common hepatic duct or hepatic bifurcation. In patients with biliary leakage, biliary drainage decreased only in two patients after ERCP and in patients with obstructive jaundice, the high bilirubin levels decreased in only one patient.
Conclusion: ERCP showed structural changes of the external biliary tract and ES has a limited effect on these changes and stents can be used in selected cases. 相似文献
Methods: We followed 13 patients who underwent ERCP for the treatment of biliary complications of HAE in the endoscopy unit of our clinic at Ataturk University School of Medicine, Erzurum between January 2002 and June 2008.
Results: Eight men and five women were followed up. Mean age was 43.2 (24–64 years). All patients had non-resectable HAE. Indications for ERCP were biliary fistula in seven patients, obstructive jaundice in five patients and cholangitis in one patient. Endoscopic sphincterotomy (ES) was carried out in 12 patients, and in one patient with biliary leakage, a stent was inserted into the right hepatic branch. ERCP findings were dilated common bile duct, irregular narrowing and distortion of the common bile duct and common hepatic duct, communication with the cystic cavity or biliocutaneous fistula and complete disappearance of the biliary tree above the level of the common hepatic duct or hepatic bifurcation. In patients with biliary leakage, biliary drainage decreased only in two patients after ERCP and in patients with obstructive jaundice, the high bilirubin levels decreased in only one patient.
Conclusion: ERCP showed structural changes of the external biliary tract and ES has a limited effect on these changes and stents can be used in selected cases. 相似文献
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阿卜杜艾尼·啊卜力孜 《临床肝胆病杂志》2015,(4):639-641
肝泡型包虫病(HAE)是一种严重危害中国西部人群的人畜共患寄生虫病,严重影响患者的生活质量。近年来随着根治性手术切除率的不断提高,以往认为无法根治性切除的晚期HAE患者也有根治的可能,但部分无法根治性切除的患者仍然存在并发症多、生存质量差等问题,因此HAE被认为是难治性、复杂性疾病。单纯传统专业组讨论的经验性诊治模式不能准确地应用多个学科临床技能全方位专业化、规范化的诊治策略,无法满足晚期难治性HAE的治疗;多个学科协作诊治模式能够有机地结合目前各项治疗方式的优点,制订合理的个体化综合治疗方案。对当前HAE多学科个体化治疗作一综述,认为多学科协作综合个体化治疗是晚期难治性HAE的首选治疗方法,是患者获得长期生存的最佳手段。 相似文献
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目的了解包虫病的超声影像学特征。方法对四川省石渠县人群进行包虫病B超检查和血清学检查以确诊病人,利用WHO-IWGE提出的分型标准和卫生部包虫病诊断标准进行分析。结果检查出了187名包虫病病人,两型包虫病的各型均有发现,并对其进行了分型,观察和描述各型病灶超声影像学表现,并对各型病灶所在肝脏位置进行了统计。 相似文献
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目的分析4种手术方式(A、B、C、D)治疗肝包虫病的成本-效果,比较其有效性和经济性。方法收集2005-2013年新疆9家医院住院的757例肝包虫手术患者临床资料和费用信息,比较4种手术方式的临床疗效、成本-效果比和增量成本-效果比。结果 4种手术方式总并发症发生率依次为15.8%、9.2%、0、2.9%;复发率依次为7.3%、6.2%、0、0;治愈率依次为77.8%、84.6%、100.0%和97.1%;成本依次为11947.3元、18543.6元、25510.7元和18877.4元;C/E依次为153.6、219.1、255.1和194.3;△C/△E依次为964.4、610.4和358.0;进行物价因素调整后,与原成本-效果分析结果一致。结论外膜内外囊完整切除术(D法)是既有效又经济的最理想手术方式,值得实施推广。 相似文献
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目的 分析晚期肝多房棘球蚴病患者临床特征,为该病诊断及治疗提供参考依据。方法 回顾性分析2012–2017年青海大学附属医院确诊的175例晚期肝多房棘球蚴病患者临床特征。结果 175例晚期肝多房棘球蚴病患者中,男女比例为1∶1.6;年龄11~69岁,平均(38.6 ± 12.9)岁;患者以藏族为主(164 例,占93.7%),主要来自果洛州(139例,占79.4%),职业以牧民为主(129例,占73.7%),文化程度以文盲为主(102例,占58.3%)。患者主要临床症状为上腹部疼痛、皮肤黏膜及巩膜黄染,病灶主要位于左右肝(占69.1%),2个及以上病灶者占63.4%,下腔静脉肝内段受累占53.7%。邻近器官受累以膈肌为主(21.7%),远处转移以肺部为主(占40.6%)。结论 青海省果洛州晚期肝多房棘球蚴病患病率较高,应针对该地区人群展开筛查,制定合理治疗方案。
[关键词] 相似文献
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泡型棘球蚴病分布地域广泛,主要流行于畜牧业发达的地区,是一种严重危害人类健康和畜牧业生产的人兽共患病,现就治疗现状作一综述。 相似文献