小儿肝囊型包虫病152例临床特征及诊治分析
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摘要
目的探讨小儿肝囊型包虫病的临床特点及诊治经验。方法回顾性分析2010年1月至2017年1月由新疆医科大学第一附属医院收治的152例肝囊型包虫病患儿的临床资料,对其临床表现、类型、诊断及治疗方法进行总结分析。结果本组152例患儿,其中肝内多发性包虫病52例,合并其他脏器包虫病26例,复发包虫病4例。病变部位多位于右半肝,多因右上腹疼痛、腹胀或体检时发现。手术治疗149例,药物治疗3例。其中行内囊摘除+外囊次全切除术97例,行外囊完整剥离术18例,行单纯内囊摘除术34例。所有患儿随访1～2年,经手术治疗的患儿均痊愈,无复发,术后残腔积液19例,其中合并感染5例,经药物治疗后均痊愈。药物治疗的患儿2例治疗6个月后予手术治疗,1例治疗后随访建议继续药物治疗。结论小儿囊型包虫具有生长速度较快、易肝内多发包虫、多脏器包虫、易破裂等特点。以手术治疗为主,药物治疗为辅。外生型囊型包虫病首选内囊摘除+外囊次全切除术,单纯肝内型囊型包虫病首选单纯内囊摘除术。
Objective To explore the clinical characteristics,diagnosis and treatment of hepatic cystic echinococosis in children. Methods The clinical data of 152 pediatric patients with hepatic cystic echinococcosis were analyzed. Their clinical characteristics,manifestations,types,diagnosis and treatment were retrospectively reviewed. Results All patients included intrahepatic multiple cystic echinococcosis( n = 52),hydatid disease involving other organs( n = 26) and recurrent echinococcosis( n = 4). Most sites were located in right half liver and there were right epigastric pain,abdominal distention and detection during physical examination.Among them,149 patients were operated and 3 patients received medications. The follow-up period was 1-2 years. All operated patients were cured without recurrence. Among 19 cases of postoperative residual cavity effusion,5 cases were complicated with infection,and then treated with drugs. Among those medicated ones,2 were re-operated after 6 months and 1 received continued drug therapy. Conclusion Hydatid cyst in children has the unique characteristics of fast growth,easy occurrence of multiple haydatid cyst,multiple organ echinococcosis and easy rupture. Surgical treatment is primary while drug therapy remains secondary. According to the different growth periods of echinococcosis,the first choice of surgical methods is different. Removal of internal capsule plus subtotal resection of external capsule is the best choice for exogenous hepatic cystic echinococcosis while simple internal capsule extirpation is indicated for endogenetic hepatic cystic echinococcosis.
Objective To explore the clinical characteristics,diagnosis and treatment of hepatic cystic echinococosis in children. Methods The clinical data of 152 pediatric patients with hepatic cystic echinococcosis were analyzed. Their clinical characteristics,manifestations,types,diagnosis and treatment were retrospectively reviewed. Results All patients included intrahepatic multiple cystic echinococcosis( n = 52),hydatid disease involving other organs( n = 26) and recurrent echinococcosis( n = 4). Most sites were located in right half liver and there were right epigastric pain,abdominal distention and detection during physical examination.Among them,149 patients were operated and 3 patients received medications. The follow-up period was 1-2 years. All operated patients were cured without recurrence. Among 19 cases of postoperative residual cavity effusion,5 cases were complicated with infection,and then treated with drugs. Among those medicated ones,2 were re-operated after 6 months and 1 received continued drug therapy. Conclusion Hydatid cyst in children has the unique characteristics of fast growth,easy occurrence of multiple haydatid cyst,multiple organ echinococcosis and easy rupture. Surgical treatment is primary while drug therapy remains secondary. According to the different growth periods of echinococcosis,the first choice of surgical methods is different. Removal of internal capsule plus subtotal resection of external capsule is the best choice for exogenous hepatic cystic echinococcosis while simple internal capsule extirpation is indicated for endogenetic hepatic cystic echinococcosis.
引文
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3阿布力克木,阿米娜·吾苏尔,艾买提江,等.人畜共患包虫病的综合防控技术[J].中国畜牧兽医文摘,2015,31(11):102.Ablikemu,Amina Wusuer,Aimaitijiang,et al.Comprehensive prevention and control technology of zoonotic echinococcosis[J].Chinese Abstracts of Animal Husbandry and Veterinary Medicine,2015,31(11):102.
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7中国医师协会外科医师分会包虫病外科专业委员会.肝两型包虫病诊断与治疗专家共识(2015版)[J].中华消化外科杂志,2015,14(4):253-264.DOI:10.3760/cma.j.issn.1673-9752.2015.04.001.Chinese College of Surgeons(CCS)Chinese Committee for Hadytidology(CCH).Expert consensus on the diagnosis and treatment of hepatic cystic and alveolar echinococcosis(2015edition)[J].Chin J Dig Surg,2015,14(4):253-264.DOI:10.3760/cma.j.issn.1637-9753.2015.04.001.
8 Patkowski W,Krasnodbski M,Gr t M,et al.Surgical treatment of hepatic echinococcus granulosus[J].Prz Gastroenterol,2017,12(3):199-202.DOI:10.5114/pg.2017.70473.
9玉苏甫·艾则孜.肝囊型包虫病合并肺囊型包虫病诊治分析[D].新疆医科大学,2014.Yusufu Aizezi.Clinical analysis for patients with hepatic-pulmonary cystic echinococcosis[D].Xinjiang Medical University,2014.
10 Moroni S,Moscatelli G,Bournissen FG,et al.Abdominal cystic echinococcosis treated with albendazole:a pediatric cohort study[J].Plos One,2016,11(9):e0160472.DOI:10.1371/journal.pone.0160472.
11 Ye J,Zhang Q,Ma L,et al.Immunological characteristics of recurrent echinococcosis-induced anaphylactic shock[J].Am J Trop Med Hyg,2016,94(2):371-377.DOI:10.4269/ajtmh.15-0386.
12温浩.肝包虫病诊断和手术治疗新进展[J].中华消化外科杂志,2011,10(4):290-292.DOI:10.3760/cma.j.issn.1673-9752.2011.04.014.Wen H.Advancement of diagnosis and surgical treatment for hepatic echinococcosis[J].Chin J Dig Surg,2011,10(4):290-292.DOI:10.3760/cma.j.issn.1673-9752.2011.04.014.
13冉博,吐尔干·艾力,邵英梅,等.小儿肝囊性包虫病的诊断与外科治疗(附67例报告)[J].中华小儿外科杂志,2011,(12):893-895.DOI:10.3760/cma.j.issn.0253-3006.2011.12.005.Ran B,Tuerga Aili,Shao YM,et al.Diagnosis and treatment of hepatic hydatid cyst in children:(67 cases of report)[J].Chin J Padiatr Surg,2011,32(12):893-895.DOI:10.3760/cma.j.jssn.0253-3006.2011.12.005.
14 Eckert J,Deplazes P.Biological,epidemiological,and clinical aspects ofechinococcosis,a zoonosis of increasing concern[J].Clin Microbiol Rev,2004,17(1):107-135.DOI:10.1128/CMR.17.1.107-135.2004.
15陈哲宇.肝包虫病的治疗方法选择[J].中华临床医师杂志(电子版),2015,9(18):3329-3331.DOI:10.3877/cma.j.issn.1674-0785.2015.18.005.Chen ZY.Choice of treatment hepatic hydatid disease[J].Chin J Clinicians(Electronic Edition),2015,9(18):3329-3331.DOI:10.3877/cma.j.issn.1674-0785.2015.18.005.
2罗超英,刁红亮,马尔丹,等.小儿肝包虫病110例特点及诊治分析[J].新疆医科大学学报,2008,31(9):1303-1303.DOI:10.3969/j.issn.1009-5551.2008.09.076.Luo CY,Diao HL,Maerdan,et al.Analysis of characteristic,diagnosis and treatment of hepatic echinococcosis in children:a report of 110 cases[J].Journal of Xinjiang Medical University,2008,31(9):1303.DOI:10.3969/j.issn.1009-5551.2008.09.076.
3阿布力克木,阿米娜·吾苏尔,艾买提江,等.人畜共患包虫病的综合防控技术[J].中国畜牧兽医文摘,2015,31(11):102.Ablikemu,Amina Wusuer,Aimaitijiang,et al.Comprehensive prevention and control technology of zoonotic echinococcosis[J].Chinese Abstracts of Animal Husbandry and Veterinary Medicine,2015,31(11):102.
4 Jairajpuri ZS,Jetley S,Hassan MJ,et al.Hydatid disease in childhood:revisited report of an interesting case[J].J Parasit Dis,2012,36(2):265-268.DOI:10.1007/s12639-012-0127-y.
5 Lv H,Jiang Y,Liu G,et al.Surgical treatment of multiple hydatid cysts in the liver of a pediatric patient[J].Am J Trop Med Hyg,2015,92(3):595-598.DOI:10.4269/ajtmh.14-0445.
6黄瑞,鲍海华,李伟霞,等.儿童肝泡球蚴病影像学分型、PNM分期及其生长特性的研究[J].实用放射学杂志,2016,32(6):926-929.DOI:10.3969/j.issn.1002-1671.2016.06.026.Hunag R,Bao HH,Li WX,et al.Analysis of imaging classification,PNM staging and growth charactristics of hepatic alveolar echinococcosis in children[J].J Pract Radial,2016,32(6):926-929.DOI:10.3969/j.issn.1002-1671.2016.06.026.
7中国医师协会外科医师分会包虫病外科专业委员会.肝两型包虫病诊断与治疗专家共识(2015版)[J].中华消化外科杂志,2015,14(4):253-264.DOI:10.3760/cma.j.issn.1673-9752.2015.04.001.Chinese College of Surgeons(CCS)Chinese Committee for Hadytidology(CCH).Expert consensus on the diagnosis and treatment of hepatic cystic and alveolar echinococcosis(2015edition)[J].Chin J Dig Surg,2015,14(4):253-264.DOI:10.3760/cma.j.issn.1637-9753.2015.04.001.
8 Patkowski W,Krasnodbski M,Gr t M,et al.Surgical treatment of hepatic echinococcus granulosus[J].Prz Gastroenterol,2017,12(3):199-202.DOI:10.5114/pg.2017.70473.
9玉苏甫·艾则孜.肝囊型包虫病合并肺囊型包虫病诊治分析[D].新疆医科大学,2014.Yusufu Aizezi.Clinical analysis for patients with hepatic-pulmonary cystic echinococcosis[D].Xinjiang Medical University,2014.
10 Moroni S,Moscatelli G,Bournissen FG,et al.Abdominal cystic echinococcosis treated with albendazole:a pediatric cohort study[J].Plos One,2016,11(9):e0160472.DOI:10.1371/journal.pone.0160472.
11 Ye J,Zhang Q,Ma L,et al.Immunological characteristics of recurrent echinococcosis-induced anaphylactic shock[J].Am J Trop Med Hyg,2016,94(2):371-377.DOI:10.4269/ajtmh.15-0386.
12温浩.肝包虫病诊断和手术治疗新进展[J].中华消化外科杂志,2011,10(4):290-292.DOI:10.3760/cma.j.issn.1673-9752.2011.04.014.Wen H.Advancement of diagnosis and surgical treatment for hepatic echinococcosis[J].Chin J Dig Surg,2011,10(4):290-292.DOI:10.3760/cma.j.issn.1673-9752.2011.04.014.
13冉博,吐尔干·艾力,邵英梅,等.小儿肝囊性包虫病的诊断与外科治疗(附67例报告)[J].中华小儿外科杂志,2011,(12):893-895.DOI:10.3760/cma.j.issn.0253-3006.2011.12.005.Ran B,Tuerga Aili,Shao YM,et al.Diagnosis and treatment of hepatic hydatid cyst in children:(67 cases of report)[J].Chin J Padiatr Surg,2011,32(12):893-895.DOI:10.3760/cma.j.jssn.0253-3006.2011.12.005.
14 Eckert J,Deplazes P.Biological,epidemiological,and clinical aspects ofechinococcosis,a zoonosis of increasing concern[J].Clin Microbiol Rev,2004,17(1):107-135.DOI:10.1128/CMR.17.1.107-135.2004.
15陈哲宇.肝包虫病的治疗方法选择[J].中华临床医师杂志(电子版),2015,9(18):3329-3331.DOI:10.3877/cma.j.issn.1674-0785.2015.18.005.Chen ZY.Choice of treatment hepatic hydatid disease[J].Chin J Clinicians(Electronic Edition),2015,9(18):3329-3331.DOI:10.3877/cma.j.issn.1674-0785.2015.18.005.