泡型包虫病手术治疗的现状与进展

泡型包虫病的手术治疗方式包括根治性切除(根治性肝切除术)、姑息性切除(姑息性肝切除术)、自体及异体肝移植术。根治性肝切除术是泡型包虫病最为有效的治疗方法, 但因泡型包虫病患者早期无明显症状, 大部分患者就诊时已处于中晚期, 失去了根治性切除机会。姑息性肝切除术治疗泡型包虫病, 其预后与残余病灶体积有关;切除90%以上病灶, 并持续服用阿苯达唑者疗效几乎与根治性切除相当。对于已无法切除且无脑转移的泡型包虫病患者, 可行同种异体或自体肝移植术, 并于术后持续服用阿苯达唑治疗。本文对泡型包虫病手术治疗的现状与进展进行综述, 以期为泡型包虫病的正确术式选择提供参考依据。     

我国泡型包虫病流行概况的补述

我国泡型包虫病流行概况的补述蒋次鹏泡型包虫病（ＡＥ）是由多房棘球绦虫幼虫引起的一型包虫病，又称泡球蚴病，国内并非罕见，其地区分布虽较细粒棘球蚴囊型包虫病（ＣＥ）局限，但危害性非浅，病死率高。笔者自１９８３、１９９１年相继综述后￣［１，２］，我国部分省...     

超声诊断肝包虫病的临床价值

包虫病又称棘球蚴病,是棘球绦虫的幼虫寄生在人体内引起的疾病。包虫病在我国有两种,即细粒棘球蚴引起的囊型包虫病和多房棘球蚴引起的泡型包虫病。在牧区工作生活的人或曾去过牧区的人,以及做屠宰、皮毛等工作的人都有可能感染包虫病。我国已有22个省（市）、自治区存在当地感染的囊型包虫病人。泡型包虫病在宁夏、新疆、甘肃、四川、青海、西藏和黑龙江有病例报告。包虫病是危害人畜的重要寄生虫病,属法定丙类传染病．     

HBV感染对肝泡型包虫病肝切除患者术后肝功能及糖脂代谢和胰岛β细胞功能的影响

目的探讨乙型肝炎病毒(HBV)感染对肝泡型包虫病肝切除患者术后肝功能、糖脂代谢和胰岛β细胞功能的影响。方法选择2017年2月-2019年12月南阳医学高等专科学校第一附属医院收治的85例肝泡型包虫病合并HBV感染患者及35例单纯肝泡型包虫病患者纳入肝泡型包虫病合并HBV感染组及单纯肝泡型包虫病组,根据HBsAg定量结果将肝泡型包虫病合并HBV感染组患者分为低载量组(200 IU/ml, 27例)、中载量组(200～20 000 IU/ml, 33例)、高载量组(20 000 IU/ml, 25例),患者均行根治性肝切除术,收集围手术期指标,测定术前及术后1 d、3 d时肝功能、糖脂代谢、胰岛β细胞功能指标。结果肝泡型包虫病合并HBV感染组手术前后肝功能指标总胆红素(TBIL)、直接胆红素(DBIL)、丙氨酸转氨酶(ALT)及天冬氨酸转氨酶(AST)均高于单纯肝泡型包虫病组(P0.05),低载量组、中载量组、高载量组手术前后各时间点肝功能指标比较差异无统计学意义。各组患者术前空腹血糖(FPG)比较差异无统计学意义,肝泡型包虫病合并HBV感染组手术前后胰岛素抵抗指数(HOMA-IR)及术后FPG高于单纯肝泡型包虫病组,手术前后胰岛素分泌指数(IGI)低于单纯肝泡型包虫病组(P0.05);高载量组、中载量组患者手术前后HOMA-IR及术后FPG高于低载量组,手术前后IGI低于低载量组(P0.05)。结论与单纯肝泡型包虫病患者比较,HBV感染可进一步降低患者手术前后肝功能,引起糖代谢紊乱及胰岛β细胞功能的异常。     

青海达日、班玛地区小学生肝包虫病患病情况调查

目的 了解青海达日、班玛地区小学生肝包虫病的患病情况。方法 用B型超声波探查腹部,对肝脏有可疑包虫肿块者采集静脉血进行包虫抗体检查,诊断标准参照《包虫病诊断标准》（WS257-2006）执行。结果 共调查956名3~17岁的小学生,最后诊断患肝包虫病19人,新发3人,总体患病率约为1.99%,其中患泡型肝包虫病16例,患病率为1.67%,患囊型肝包虫病3例,患病率为0.32%,泡型肝包虫患病率明显高于囊型肝包虫患病率,差异有统计学意义（χ2=8.98,P =0.002）。结论 达日、班玛地区在校小学生肝包虫病患率仍较高,主要以泡型肝包虫病为主,应早发现、早治疗,并广泛开展该地区的卫生宣传教育及大力宣传预防包虫病的知识,控制传染源,对家犬及流浪犬进行驱虫防疫处理等是包虫病防治工作的重点。     

卫生部办公厅关于印发《包虫病防治技术方案(试行)》的通知

包虫病是由棘球蚴属绦虫寄生于人体或宿主动物体内而引起的人兽共患寄生虫病，是全球性的公共卫生问题。在我国，包虫病有囊型和泡型包虫病两种，其中，泡型包虫病由于病死率较高，被称为“虫癌”。包虫病主要流行于西部地区的牧区和半农半牧区，以新疆、青海、甘肃、宁夏、西藏、内蒙和四川西部最为严重。     

肝泡球蚴病鉴别诊断和治疗3例报告

肝泡型包虫病 (ａｌｖｃｏａｒｈｙｄａｔｉｄｄｉｓｅａｓｅ) ,又称肝多房型棘球蚴病 (ｅｃｈｉｎｏｃｏｃｃｏｓｉｓｍｌｔｉｌｏｃｕｌａｒｉｓｃｙｓｔｉ ｃｕｓ)又称“泡肝”或“肝泡球蚴病” ,是一种人畜共患寄生虫病 ,容易与肝癌、肝硬变、肝囊性包虫病相混淆 ,特别是与肝癌很难区别。本文结合 1999年 5月～ 2 0 0 0年 5月遇到 3例典型病例 ,就肝泡型包虫病的诊断和外科治疗方法进行讨论。1　临床资料例 1,男 ,蒙古族 ,牧民 ,有牛羊密切接触史。右上腹部胀痛不适 2 0ｄ ,伴恶心、呕吐 ,腹部检查右上腹部肋缘下深压痛阳性 ,肝肋缘下 3…     

儿童青少年包虫病流行现状与防治措施

包虫病(echinococcosis)是棘球绦虫的幼虫(棘球蚴)所致的人兽共患寄生虫病,主要包括由细粒棘球蚴引起的囊型包虫病(cystic echinococcosis,CE)和多房棘球蚴引起的泡型包虫病(alveolar echinococcosis,AE)[1].我国囊型包虫病人占大多数,泡型包虫病因类似肿瘤的生长方式及高达94%以上的10年病死率,又被称为“虫癌”[2].包虫病一般多发生于成人,但感染的高峰年龄主要为儿童期.     

包虫病防治

包虫病是由棘球属绦虫的幼虫棘球蚴(又称包虫)寄生引起的一类人兽共患疾病。细粒棘球绦虫和多房棘球绦虫是引起人类包虫病的主要病源,前者引起囊型包虫病(囊型棘球蚴病),呈全球性分布,后者引起泡型包虫病(泡型棘球蚴病),仅分布于北半球。随着世界畜牧资源的开发和不断扩散,包虫病已成为全球性的公共卫生问题。细粒棘球绦虫(echinococcus granulosus)的终宿主是犬、狼和豺等犬科动物,成虫寄生在其体内;中间宿主是羊、牛、骆驼、猪和鹿等偶蹄类,偶可感染马、袋鼠,某些啮齿类、灵长类和人,幼虫(称棘球蚴)寄生于中间宿主体内。多房棘球绦虫(echi…     

779例包虫病住院病例调查研究

目的了解青海大学医学院附属医院779例包虫病住院病历概况。方法对青海大学医学院附属医院建院1958-2001年779例包虫病住院病历资料进行整理、统计、分析。结果青海省包虫病是以囊性包虫病为主,同时也有部分泡型包虫病存在的混合病型;患者中女性高于男性;民族分布以藏族较多,汉族次之,牧民患病人数明显高于其他职业人群;患者以青年肝包虫为主,其次为腹腔包虫和肺包虫。结论目前在治疗中仍以手术治疗为主,其效果也最好。     

Echinococcosis in Ningxia Hui Autonomous Region, northwest China

Cystic echinococcosis (CE), caused by Echinococcus granulosus, and alveolar echinococcosis (AE), due to E. multilocularis, are endemic to large areas of north and northwest China. Here we review features of a severe focus of AE and CE in Ningxia Hui Autonomous Region (NHAR), northwest China. We describe for NHAR the results of surveys of hospital surgical and clinical records, including treatment of AE and CE, and active community detection of asymptomatic/early-stage cases and patient follow-up using questionnaire analysis, ultrasound examinations and serology. We compare the key risk factors for both AE and CE in this setting with those reported from other areas. In addition, we document the socio-economic factors impacting on treatment and control of AE and CE. This update indicates that echinococcosis continues to be highly endemic in NHAR and exemplifies the serious public health problem that the disease presents, particularly in poor rural areas. Extensive community surveys of echinococcosis are required throughout northwest China, especially in rural communities. These will enable earlier detection of echinococcosis cases, thereby improving treatment outcomes, and reveal the true epidemiological picture regarding the disease in this region, with a view to developing and implementing new strategies for future control.     

青藏高原地区泡型包虫病患者住院费用影响因素分析

目的 分析泡型包虫病（alveolar echinococcosis,AE）患者住院费用变化趋势及其主要影响因素,为AE的综合防治及控制住院费用提供参考依据。方法 收集2004年4月~2016年1月青海省两家三甲医院收治的肝AE患者的临床及住院费用相关资料,并采用多因素Logistic回归法分析住院费用的影响因素。结果 收集AE患者300例,其中男性132例（44.0%）,女性168例（56.0%）,平均年龄为（38.87±13.62）岁。藏族病例为225例（75.0%）,住院天数中位数为15（1~102） d,总住院费用的中位数为14 115.25（361.20~187 670.60）元,其中西药费占36.0%、诊断费占20.0%、耗材费占19.0%、治疗费占13.0%。多因素Logistic回归分析发现:住院天数、手术与否、付费方式及有无合并疾病是影响住院费用的主要因素,差异均具有统计学意义（均有P<0.05）。结论 近年来,AE住院费用呈逐年上升趋势,合并其他诊断、治疗方式及付费方式均是患者住院费用的影响因素,因此选择合适的治疗方式、制定合理的单病种管理措施等可能是控制住院费用的必要措施。     

Human alveolar echinococcosis: an emerging zoonosis in Hungary and Europe

Human alveolar echinococcosis, caused by the metacestode stage of Echinococcus multilocularis, is one of the most dangerous zoonoses in the temperate and arctic areas of northern hemisphere. The mortality of the disease exceeds 95% in untreated or inadequately treated patients. In the past three decades, the spread of this parasite was observed in Europe as a consequence of human interventions resulting in the population size increase of foxes. The authors demonstrated the presence of E. multilocularis in foxes in all northern counties of Hungary and the existence of hyperendemic regions in the Counties Nógrád and Gyor-Moson-Sopron. The aim of the present paper is to summarize the current knowledge on the life cycle and distribution of E. multilocularis, and the epidemiology, clinical features, diagnosis, treatment and control of human alveolar echinococcosis.     

Echinococcus multilocularis: An Emerging Pathogen in Hungary and Central Eastern Europe?

Echinococcus multilocularis, the causative agent of human alveolar echinococcosis, is reported for the first time in Red Foxes (Vulpes vulpes) in Hungary. This parasite may be spreading eastward because the population of foxes has increased as a consequence of human interventions, and this spread may result in the emergence of alveolar echinococcosis in Central Eastern Europe.     

European echinococcosis registry: human alveolar echinococcosis,Europe, 1982-2000

Surveillance for alveolar echinococcosis in central Europe was initiated in 1998. On a voluntary basis, 559 patients were reported to the registry. Most cases originated from rural communities in regions from eastern France to western Austria; single cases were reported far away from the disease-"endemic" zone throughout central Europe. Of 210 patients, 61.4% were involved in vocational or part-time farming, gardening, forestry, or hunting. Patients were diagnosed at a mean age of 52.5 years; 78% had symptoms. Alveolar echinococcosis primarily manifested as a liver disease. Of the 559 patients, 190 (34%) were already affected by spread of the parasitic larval tissue. Of 408 (73%) patients alive in 2000, 4.9% were cured. The increasing prevalence of Echinococcus multilocularis in foxes in rural and urban areas of central Europe and the occurrence of cases outside the alveolar echinococcosis-endemic regions suggest that this disease deserves increased attention.     

7830例矽尘作业工人肺功能检查分析

为了解青海省矽尘作业工人肺部损伤情况，将“职业病与职业卫生信息监测系统”2017年矽尘作业工人肺功能检查结果导出并分析。7830例矽尘作业工人FVC%、FEV，%和FEV/FVC%异常检出率分别为22.6%、11.6%和2.8%；三项指标在地区分布、企业规模、经济类型、行业分布间差异有统计学意义（P<0.01）。应加强对矽尘作业工人的定期肺功能检查，早期发现肺部损伤，保护劳动者健康。     

Risk factors for alveolar echinococcosis in humans

We conducted a case-control study to investigate risk factors for acquiring autochthonous alveolar echinococcosis in Germany. Forty cases and 120 controls matched by age and residence were interviewed. Patients were more likely than controls to have owned dogs that killed game (odds ratio [OR] = 18.0), lived in a farmhouse (OR = 6.4), owned dogs that roamed outdoors unattended (OR = 6.1), collected wood (OR = 4.7), been farmers (OR = 4.7), chewed grass (OR = 4.4), lived in a dwelling close to fields (OR = 3.0), gone into forests for vocational reasons (OR = 2.8), grown leaf or root vegetables (OR = 2.5), owned cats that roamed outdoors unattended (OR = 2.3), and eaten unwashed strawberries (OR = 2.2). Sixty-five percent of cases were attributable to farming. Measures that prevent accidental swallowing of possibly contaminated material during farming or adequate deworming of pet animals might reduce the risk for alveolar echinococcosis.     

Species identification of human echinococcosis using histopathology and genotyping in northwestern China

Human cystic echinococcosis, caused by infection with the larval stage of Echinococcus granulosus, and alveolar echinococcosis, caused by the larval form of E. multilocularis, are known to be important public health problems in western China. Echinococcus shiquicus is a new species of Echinococcus recently described in wildlife hosts from the eastern Tibetan plateau and its infectivity and/or pathogenicity in humans remain unknown. In the current study, parasite tissues from various organs were collected post-operatively from 68 echinococcosis patients from Sichuan and Qinghai provinces in eastern China. The tissues were examined by histopathology and genotyped using DNA sequencing and PCR-RFLP. Histopathologically, 38 human isolates were confirmed as E. granulosus and 30 as E. multilocularis. Mitochondrial cob gene sequencing and PCR-RFLP with rrnL as the target gene confirmed 33 of 53 of the isolates to have the G1 genotype of sheep/dog strain of E. granulosus as the only source of infection, while the remaining 20 isolates were identified as E. multilocularis. No infections were found to be caused by E. shiquicus. Additionally, 5 of 20 alveolar echinococcosis patients were confirmed to have intracranial metastases from primary hepatic alveolar echinococcosis lesions. All these cases originated from four provinces or autonomous regions but most were distributed in Sichuan and Qinghai provinces, where high prevalence rates of human alveolar echinococcosis and cystic echinococcosis were previously documented.     

Human Alveolar Echinococcosis in Kyrgyzstan

Human echinococcosis is a reportable disease in Kyrgyzstan. Between 1995 and 2011, human alveolar echinococcosis increased from <3 cases per year to >60 cases per year. The origins of this epidemic, which started in 2004, may be linked to the socioeconomic changes that followed the dissolution of the former Soviet Union.     

Community surveys and risk factor analysis of human alveolar and cystic echinococcosis in Ningxia Hui Autonomous Region, China

OBJECTIVE: To determine the true community prevalence of human cystic (CE) and alveolar (AE) echinococcosis (hydatid disease) in a highly endemic region in Ningxia Hui, China, by detecting asymptomatic cases. METHODS: Using hospital records and "AE-risk" landscape patterns we selected study communities predicted to be at risk of human echinococcosis in Guyuan, Longde and Xiji counties. We conducted community surveys of 4773 individuals from 26 villages in 2002 and 2003 using questionnaire analysis, ultrasound examination and serology. FINDINGS: Ultrasound and serology showed a range of prevalences for AE (0-8.1%; mean 2%) and CE (0-7.4%; mean 1.6%), with the highest prevalence in Xiji (2% for CE, 2.5% for AE). There were significant differences in the prevalence of CE, AE and total echinococcosis between the three counties and villages (with multiple degrees of freedom). While hospital records showed 96% of echinococcosis cases attributable to CE, our survey showed a higher prevalence of human AE (56%) compared to CE (44%). Questionnaire analysis revealed that key risk factors for infection were age and dog ownership for both CE and AE, and Hui ethnicity and being female for AE. Drinking well-water decreased the risk for both AE and CE. CONCLUSION: Echinococcosis continues to be a severe public health problem in this part of China because of unhygienic practices/habits and poor knowledge among the communities regarding this disease.