重度脑囊虫病服药治疗期间外科治疗的必要性

目的探讨重度脑囊虫病减量法口服丙硫咪唑治疗期间外科协同治疗的必要性。方法将同期住院治疗的209例脑囊虫病人分为轻中度组（135例）和重度组（74例）。服药治疗期间使用降颅压药，包括脱水剂和减轻脑水肿药物（糖皮质激素、七叶皂甙钠、白蛋白）。药物降颅压无效者行脑室外引流术或／和颞肌减压术。结果在口服丙硫咪唑治疗时，轻中度脑囊虫病组1．5％行外科治疗，重度脑囊虫病组90．5％行外科治疗，两组比较有显著的统计学差异性（P〈0．01）。轻中度组102例患者治疗后进行随访平均29．4月，重度脑囊虫病组中有69例在治疗后随访平均37．2月。两组患者随访中经复查CT或MRI，除1例（脑内虫体数量达1160个）治疗失败外，其余患者均达到临床治愈。结论重度脑囊虫病患者在减量法服丙硫咪唑治疗期间，行药物降颅压治疗应同时使用外科降颅压措施，这样才能使患者顺利度过治疗期。

Necessity of surgical intervention in the treatment of severe neurocysticercosis

Objective To study the necessity of surgical intervention on intracranial hypertension during albendazole treatment of severe neurocysticercosis. Methods 209 patients with neu-rocysticercosis were confirmed in diagnosis by neuroimaging techniques(CT and/or MRI) and ELISA for the detection of antibody to cysticerci of taenia solium. All patients were divided into mild-middle group(135 cases) and severe group(74 cases) and treated with albendazole by dose-reducing regimen. Drugs reducing intracranial pressure were used to all patients during treatment, including mannitol, corticosteroids and/or sodium aeacine. When albendazole did not work, patients with intracranial hypertension were treated by surgery including drainage of cerebral ventricle and/or decompression of temporal muscle. Results The rate of surgical intervention was 90.5%(67/74) in severe group but 1.5%(2/135) in mild-middle group. There was a significant statistical difference(P < 0.01) in rate of surgical intervention between two groups. Treated patients were followed up by an average of 29.4 months in mild-middle group(102/135) and an average of 37.2 months in severe group(69/74). In these followed cases, CT and/or MRI confirmed that cysts had disappeared or become calcified except in one case due to 1160 cysts in the patient's brain. Conclusion Surgical intervention in reducing intracranial pressure is a necessary, safe and effective method in the treatment of severe neurocysticercosis.