丙硫咪唑治疗重度脑囊虫病初始剂量临床研究

目的探讨丙硫咪唑减量法治疗重度脑囊虫病的初始耐受剂量。方法将74例根据囊尾坳数量分为A（100-199个）、B（200-299个）、C（300-399个）、D（≥400个）4组。用丙硫咪唑减量法找到初始耐受剂量，然后逐渐递增至治疗剂量。按治疗剂量服丙硫咪唑3-4个疗程，每个疗程10天。服药治疗期间使用降颅压药，药物降颅压无效者行外科降颅压治疗。结果各组初始耐受剂量为治疗剂量：A组400-600mg／d，B组300-600mg／d，C组200-500mg／d，D组200-400mg／d。服药治疗期间有67例行外科治疗。74例患者中随访69例，随访时间19-52个月，平均37．2个月；复查CT或MRI，除1例（脑内虫体数量迭1160个）治疗失败外，其余68例均治愈。结论对于重度脑囊虫病的治疗，根据虫体数的不同，丙硫咪唑初始剂量为治疗剂量的1／2-1／5，同时采用外科降颅压可使患者顺利度过治疗期。     

105例脑囊虫患者的护理

１０５例脑囊虫患者的护理高庆鲜潘栓珍金便芬张兰俊第二临床医学院神经内科（０５００００）关键词脑囊虫病；高颅压；护理学脑囊虫病常见，目前主要应用丙硫咪唑或吡喹酮治疗，治疗过程中易引起高颅压反应，甚至形成脑疝而死亡。因此，做好护理工作极为重要。１９９１～...     

丙硫咪唑治疗囊虫病82例疗效观察

１３年来我们用丙硫咪唑治疗囊虫病８２例，其中Ａ组（皮肌型）总有效率１００％，Ｂ组（脑囊虫病）总有效率９０％，ＡＢ两组治疗前后有非常显著性差异（Ｐ＜０．０１）。采用小剂量，长疗程的服药方法，既能杀死虫体而反应轻，表明丙硫咪唑是治疗囊虫病疗效好毒性低口服方便的药物。     

丙硫咪唑长疗程治疗脑囊虫病78例

目的　观察丙硫咪唑长疗程治疗脑囊虫病的疗效。方法　给予临床确诊的脑囊虫病 78例患者口服丙硫咪唑 15mg·kg 1·d 1,30d一疗程 ,共行 3个疗程 ,观察临床症状、影像学及实验室检查结果 ;根据疗效评定标准 ,计算有效率。结果　 78例中痊愈 2 6例 ,显效 5 1例 ,进步 1例 ,有效率 98.71% ,随访 2年未见明显异常。结论　丙硫咪唑长疗程治疗脑囊虫病近远期疗效均佳 ,且不良反应少 ,较安全、经济。     

丙硫咪唑长疗程治疗脑囊虫病78例

观察丙硫咪唑长疗程治疗脑囊虫病的疗效。方法给予临床确诊的脑囊虫病７８例患者口服丙硫咪唑１５ｍｇ．ｋｇ＾－１．ｄ＾－１,３０ｄ一疗程,并行３个疗程,观察临床症状,影像学衣实验室检查结果,根据疗效评定标准,计算有效率。结果７８例中痊毹６例,显效５１例,进步１例,有效率９８．７１％随访２年未见明显异常。     

脑囊虫病86例临床分析

目的探讨不同类型脑囊虫病的治疗方式选择及治疗效果。方法对86例各种类型脑囊虫病患者行不同的外科治疗手段,随后给予药物灭囊,术前术后分别查CT、MRI、囊虫酶联免疫试验,术后随访3～6个月。结果本组无死亡病例,高颅压症状缓解30例,癫完全控制36例,好转20例,肢体瘫痪恢复8例,无效2例。结论脑囊虫病的治疗如经保守治疗无效,应及时选择外科手术治疗,尤其是伴有高颅压、癫频发型、大囊型,外科治疗可使患者安全渡过治疗期。     

丙硫咪唑治疗脑囊虫病49例远期疗效观察

丙硫咪唑治疗脑囊虫病４９例远期疗效观察同济医科大学附属同济医院神经科，武汉４３００３０唐荣华，杨明山关键词脑囊虫病；丙硫咪唑中图法分类号Ｒ５３２．３３，Ｒ９７８．６３脑囊虫病是中枢神经系统常见的寄生虫感染性疾病，大量临床资料表明［１～３］，丙硫咪唑是...     

丙硫咪唑与吡喹酮治疗脑囊虫的对比研究

将经临床诊断、头颅ＣＴ及脑脊液嗜酸性细胞检查证实为脑囊虫病的５０例患者随机分为两组，分别给丙硫咪唑与吡喹酮治疗，结果其治疗效果差异无显著性（Ｐ〉０．０５），但其副作用差异有显著性（Ｐ〈０．０５）。因此认为丙硫唑咪治疗脑囊虫病具有毒性低、安全可靠的特点，值得推广。     

丙硫咪唑治疗脑囊虫病体会

丙硫咪唑治疗脑囊虫病体会兰医一院脑系科肖伟忠，李大中丙硫咪唑是国外１９７６年问世的高效广谱驱虫药，国内刘惠等曾报导用丙硫咪唑治疗脑囊虫病９３９例，总有效率达９９．８％［１］我们从１９８９～１９９５年应用丙硫咪唑治疗脑囊虫病８例，亦取得了满意的疗效。１...     

丙硫咪唑治疗脑囊虫病性癫痫30例临床分析

目的:观察丙硫咪唑治疗脑囊虫病的临床治疗效果。方法:回顾性分析30例脑囊虫病性癫痫患者的临床资料,随机分为A组与B组,A组给予吡喹酮,B组给予丙硫咪唑15~20 mg/kg,分2次口服,10 d为1个疗程,共3个疗程。结果:吡喹酮治疗组总有效率效果优于丙硫咪唑治疗组,差异无统计学意义(P>0.05);不良反应发生率丙硫咪唑治疗组明显低于吡喹酮治疗组,差异有统计学意义(P<0.05)。结论:吡喹酮和丙硫咪唑对脑囊虫病患者的治疗效果相当,同时丙硫咪唑的不良反应发生率为低。     

颅内压增高型囊虫病的治疗

报告123例颅内压增高型脑囊虫病治疗的结果(吡喹酮88例,丙硫咪唑35例)。根据严格的确诊标准,治疗结束后半年全面复查按六项标准评效。吡喹酮组:痊愈15.9％,显效36.4％。16例已随访三年,疗效稳定。7例治疗前后CT所见与疗效吻合。治疗前后的生活质量有显著改变。丙硫咪唑组未显示确切效果,因病例数少,剂量分散,也不能肯定其无效。重点讨论了治疗的严重副反应,本组吡喹酮的死亡率高达10.2％。着重分析了颅内压增高反应的发生规律。认为主要是广泛大量脑实质内囊包患者的反应大,年轻、临床表现为脑(氵弥)散损伤及颅压增高严重者应特别警惕。提出了改进治疗的七项建议。     

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.     

高颅压型脑囊虫病的综合治疗

目的探讨高颅压型脑囊虫病的手术与药物治疗.方法采用回顾性研究方法对33例高颅压型脑囊虫病的临床表现、影像资料及手术方法和药物治疗进行分析.结果高颅压型脑囊虫病表现为颅内压进行性增高,依临床表现及CT、MRI检查大部分可早期诊断,但对部分不典型者常易误诊,MRI检查有助于鉴别诊断,对有明显占位或脑脊液循环梗阻者,应手术摘除囊虫;对经药物治疗后出现颅内压升高并危及生命者应行颞肌下减压.术后均应配合药物治疗.结论高颅压型脑囊虫病依其临床表现、影像资料多可早期诊断,其治疗应是手术治疗结合合理的药物治疗.     

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.

     

颅内静脉系统血栓形成的早期诊断及治疗

目的探讨颅内静脉系统血栓形成的早期诊断及治疗方法。方法分析8例颅内静脉系统血栓形成的病因、症状、体征、头颅CT和MR检查、脑电图、脑脊液及血液流变学的特点。结果病因多为产褥期及感染,常表现为颅内高压征及局灶神经功能缺损,头颅CT和MR检查可确诊。结论对于临床有颅内高压和局灶神经功能缺损表现,尤其是产褥期或有感染者,应警惕颅内静脉系统血栓形成,需行头颅CT和MR检查确诊,并尽早抗凝治疗。     

25例蛛网膜囊肿临床病理与预后

对我院１７年间收治２５例蛛网膜囊肿病人进行分析。颅内蛛网膜囊肿１７例（６８％），椎管内蛛网膜囊肿８例（３２％）；ＣＴ或ＭＲＩ对该病有诊断价值，明确诊断后均经手术治疗。１８例病人中１６例疗效较好，２例病人预后差。     

颅内蛛网膜囊肿手术治疗的临床分析

目的:探讨颅内蛛网膜囊肿的手术治疗方式及其疗效。方法:回顾性分析72例手术治疗的颅内蛛网膜囊肿患者的临床资料,神经内镜下囊壁部分切除+囊肿-脑室或脑池造瘘术16例,显微镜下囊肿切除术4例,显微镜下囊壁部分切除+囊肿-脑池造瘘术32例,囊肿-腹腔分流术20例。随访6个月～6 a(平均2.2a)。结果:67例患者经治疗后症状改善,有效率93.1%,随访CT或MRI显示83.3%(60/72)幕上蛛网膜囊肿体积显著减小,幕下蛛网膜囊肿体积无明显变化但症状显著改善。结论:有症状的蛛网膜囊肿患者均应积极治疗。针对不同患者选择合适的手术方式对预后有重要意义。神经内镜手术创伤小、并发症少,应继续推广应用。     

颅内静脉系统血栓形成的早期诊断及治疗

目的 探讨颅内静脉系统血栓形成的早期诊断及治疗方法。方法 分析8例颅内静脉系统血栓形成的病因、症状、体征、头颅CT和MR捡查、脑电图、脑脊液及血液流变学的特点。结果 病因多为产褥期及感染，常表现为颅内高压征及局灶神经功能缺损，头颅CT和MR检查可确诊。结论 对于临床有颅内高压和局灶神经功能缺损表现，尤其是产褥期或有感染者，应警惕颅内静脉系统血栓形成，需行头颅CT和MR捡查确诊，并尽早抗凝治疗。     

颅内表皮样囊肿的临床特征及显微手术治疗

目的对1994～2004年完成的颅内表皮样囊肿显微外科手术进行总结,为此种疾病今后的诊断和治疗提供有益的参考。方法对本院12例颅内表皮样囊肿患者,先行CT和MRI检查,随后在全麻下进行显微外科的手术切除。以电凝切开囊膜,将囊内实质逐步摘除,然后沿边界细心分离,逐一电凝并切断血供及粘连,彻底切除囊肿。对于粘连过于紧密的部位,宁可残余少量组织,以免出现术后严重的并发症。并在术后对患者的检查资料进行总结,对病变组织进行影像学和病理学分析。结果12例颅内表皮样囊肿患者中,8例位于桥小脑角,颅底斜坡2例,鞍区1例,脑室1例。手术切除的囊肿组织,75％(9／12例)呈不规则形态。CT平扫83．33％(10／12例)为均匀低密度,且造影后90％(9／10例)未发生强化MRI T1呈均匀低信号,与脑脊液基本类似或略高于脑脊液,T2呈均匀高信号,占75％(9／12例)。周围脑组织未发现有水肿现象;但是当瘤体较大时会引起比较明显的占位效应,占66．67％(8／12例)。结论颅内表皮样囊肿在CT和MRI检查中可见有特征性表现,为手术提供较为准确的术前诊断,术中观察和术后的病理切片均得以证实。经过显微外科手术,基本可以完全切除囊肿组织,达到较好的治疗效果。     

Continuous long-term albendazole therapy in intraabdominal cystic echinococcosis

Ａｌｂｅｎｄａｚｏｌｅｈａｓｂｅｅｎｗｉｄｅｌｙｕｓｅｄｉｎｔｈｅｔｒｅａｔｍｅｎｔｏｆｃｙｓｔｉｃｅｃｈｉｎｏｃｏｃｃｏｓｉｓ ,ｂｕｔｒｅｌａｔｉｖｅｌｙｆｅｗｌｏｎｇ ｔｅｒｍｆｏｌｌｏｗ ｕｐｒｅｓｕｌｔｓａｒｅａｖａｉｌａｂｌｅｔｏｅｖａｌｕａｔｅｌｏｎｇ ｔｅｒｍｅｆｆｉｃａｃｙａｎｄｓａｆｅｔｙ Ｉｎｔｈｉｓｓｔｕｄｙ ,ｗｅｆｏｌｌｏｗｅｄｕｐ 15ｐａｔｉｅｎｔｓｗｈｏｒｅｃｅｉｖｅｄｃｏｎｔｉｎｕｏｕｓｌｏｎｇ ｔｅｒｍａｌｂｅｎｄａｚｏｌｅｔｈｅｒａｐｙ ;ｃｌｉｎｉｃａｌｔｈｅｒａｐｅ…