148例肺包虫病患者的流行特点及手术治疗效果分析

摘要

目的 分析肺包虫病患者的流行特点及手术治疗效果.方法 选取2014年7月至2016年5月我院收治的日喀则市肺包虫病患者148例为研究对象,搜集其临床资料,比较该病在不同性别、年龄、动物接触史患者中发病率,分析肺包虫病临床表现、发病部位及影像学特征,并采用随机数表法分为观察组和对照组各74例,观察组实施开胸下肺包虫病内囊摘除术,对照组行开胸下肺包虫病全切除术,比较两组围术期指标及手术前后血浆辅助性T细胞亚群9(Th9)、白介素-9(IL-9)水平,记录术后并发症及复发情况.结果 日喀则市肺包虫病在20-50岁年龄中发病率71.62％最高,不同性别患者发病率相近,且均有牛、羊、马等动物密切接触史;肺包虫病主要表现为胸痛、咳嗽、咯血、消瘦、咳水样液或粉皮样物,发病率右肺52.70％高于左肺47.30％、下叶52.03％高于上叶47.97％,且有典型影像学征象;观察组手术时间(89.45±12.37)m in、术后拔管时间(6.63±1.17)d、住院时间(9.30±1.56)d较对照组短,术中出血量(135.46±22.17)mL低于对照组(P＜0.05);术后观察组Th9(25.45±1.78)％、IL-9(12.15±1.74) pg/mL水平较对照组明显降低(P＜0.05);两组并发症发生率(20.27％ vs 21.62％)及复发率(0vs1.35％)比较无显著差异(P＞0.05).结论 日喀则市肺包虫病发病与患者年龄、动物密切接触史有关,主要表现为胸痛、消瘦、咳嗽症状,且发病率右肺高于左肺、下叶高于上叶,采用开胸下肺包虫病内囊摘除术治疗预后较开胸下肺包虫病全切除术好,不会明显增加术后并发症与复发率,值得在临床推广应用.%Objective To analyze the epidemic characteristics and operative effect of pulmonary hydatid disease.Methods A total of 148 patients with pulmonary hydatid disease in Shigatse who were admitted to our hospital during July 2014-May 2016 were enrolled in the study.The clinical data were collected.The incidence of the disease was compared between patients of different gender,age and patients with and without animal contact history.The clinical manifestations,invasion sites and imaging features of pulmonary hydatid disease were analyzed.The patients were randomly divided into the observation group and the control group,74 cases in each group.The observation group were treated with thoracotomy and pulmonary hydatid enucleation,while the control group were treated with thoracotomy and total removal of pulmonary hydatid.The perioperative indexes,levels of plasma helper T cell subsets (Th9 9) and interleukin-9 (IL-9) were compared between the two groups.The postoperative complications and recurrence were recorded.Results The incidence of pulmonary hydatid disease in Shigatse was the highest in people aging 20-50 years old (71.62％).The incidence were similar in patients of different gender,and all subjects had animal contact history.The imaging findings of the disease were typical,and the incidence was higher in right lung than left lung (52.70％ vs 47.30％),and higher in lower lobe than upper lobe (52.03％ vs 47.97％).The operation time,postoperative extubation time and hospital stay of the observation group were shorter than those of the control group,and the intraoperative blood loss was less in the observation group than in the control group (P ＜ 0.05).Th9 and IL-9 levels were significantly lower in the observation group than in the control group (P ＜ 0.05).There was no significant difference between the two groups in the incidence of complications (20.27％ vs 21.62％) and recurrence rate (0 vs 1.35％) (P ＞ 0.05).Conclusion The incidence of pulmonary hydatid disease in Shigatse is related to age and close contact history with animals.The incidence is higher in right lung than left lung,and higher in lower lobe than the upper lobe.The prognosis of patients undergoing thoracotomy and pulmonary hydatid enucleation is better than that of patients undergoing thoracotomy and total removal of pulmonary hydatid.The former will significantly increase the incidence of postoperative complications and recurrence rate.