肺包虫病

摘要： 包虫病(echinococcosis)是一种人畜共患的流行性寄生虫疾病,人感染棘球绦虫的幼虫致病,也称棘球蚴病(hydatid disease),肝脏和肺脏是最易被侵犯的器官。曲霉菌是一种腐生性真菌,曲霉菌感染常见于免疫缺陷的患者,肺包虫病合并曲霉菌感染在免疫功能正常的患者中非常罕见,在中外文献中均为个案报道。现将兰州大学第二医院收治的1例免疫功能正常、无其他伴随疾病的双侧孤立性肺包虫病合并曲霉菌感染病例报道如下,并结合中外文献进行文献复习,为这类疾病的诊断和治疗提供一定的参考依据。

摘要： 包虫病(echinococcosis)是一种人畜共患的流行性寄生虫疾病,人感染棘球绦虫的幼虫致病,也称棘球蚴病(hydatid disease),肝脏和肺脏是最易被侵犯的器官.曲霉菌是一种腐生性真菌,曲霉菌感染常见于免疫缺陷的患者,肺包虫病合并曲霉菌感染在免疫功能正常的患者中非常罕见,在中外文献中均为个案报道.现将兰州大学第二医院收治的1例免疫功能正常、无其他伴随疾病的双侧孤立性肺包虫病合并曲霉菌感染病例报道如下,并结合中外文献进行文献复习,为这类疾病的诊断和治疗提供一定的参考依据.

摘要： 目的 探讨电视胸腔镜手术治疗肺包虫的价值.方法 回顾性分析1995年6月-2017年3月开展的118例行胸腔镜下肺包虫内囊摘除术和87例开胸肺包虫病手术的患者,收集患者基本信息及手术时间、出血量、留置胸管时间、胸管引流量、疼痛情况、术后漏气、出血、包虫残腔感染、肺部感染、支气管胸膜瘘等资料,并进行对比分析.结果 胸腔镜组手术时间105.18±23.57min,与开胸组98.56±11.37 min无显著差异,但在术中出血(28.37±6.85mL vs 91.47±10.29mL),胸管引流量(60.35±21.31mL vs120.33±11.47mL),以及术后住院时间(7.35±1.78d vs 10.14±3.75d)均有显著优势(P0.05).但胸腔镜组术后包裹性液气胸发生率(8.47％vs 18.39％)明显降低.结论 胸腔镜治疗肺包虫病较开胸治疗安全,有效.

摘要： 目的 总结并研究对肺包虫病患者进行电视胸腔镜治疗的临床治疗体会.方法 选择2015年2月—2018年2月在我院治疗肺包虫病的患者60例作为研究对象.依照计算机表法,将其分为两组.试验组(n=30)进行电视胸腔镜的治疗,对照组(n=30)进行胸廓切口显露囊肿手术治疗,比较两组患者的临床治疗效果.结果 试验组患者的平均手术时间、平均抗生素注射时间、平均胸腔闭式引流管拔管时间、平均住院时间均短于对照;试验组患者的平均术中出血量少于对照组;试验组中产生支气管胸膜瘘、肺膨胀的患者例数均少于对照组,组间各数据比较,差异具有统计学意义(P<0.05).结论 应用电视胸腔镜治疗肺包虫病,临床治疗效果更加显著,能够有效减轻手术对患者带来的疼痛,手术造成的创伤相对较小,有利于促进患者术后的痊愈,能够减轻患者的病痛,降低肺部感染以及肺不张等并发症发生的可能.

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.

摘要： 目的:探讨肺包虫病手术的麻醉管理。方法:2017年1月至2017年12月就诊于日喀则市人民医院行手术治疗的肺包虫病的患者,选用双腔气管插管静脉复合麻醉。术中积极处理囊肿破裂、过敏性休克等。结果:60例肺包虫病患者,均取得较满意的麻醉效果。术中1例病人出现包虫囊肿破裂导致的过敏性休克,在及时处理后顺利出院。儿童患者也能取得满意的麻醉效果。结论:肺包虫病手术中的麻醉管理和对术中过敏性休克的处理直接关系到肺包虫病患者的生命安全、手术的成败。

摘要： Objective To evaluate the clinical value of video -assisted thoracoscopic surgery ( VATS) in the treatment of pediatric pulmonary hydatid disease .Methods The clinical data of 50 pediatric pulmonary hydatid patients who under-went VATS(as a VATS group) and 46 pediatric pulmonary hydatid patients who underwent thoracotomy (as a thoracotomy group) wereretrospectively analyzed in People′s Hospital of Uygur Autonomous Region between Jan .2002 and Dec.2015, the effect of the two groups were compared .Results The amount of intraoperative blood loss of the VATS group was less than that of the thoracotomy group[(10.16 ±1.80) mL vs (19.31 ±3.27) mL],and the retention time after surgery was less than that of the thoracotomy group[(3.28 ±0.18) d vs (5.16 ±1.62) d](P0.05).Conclusion VATS is a safe technique for the treatment of pediatric pulmonary hydatid disease ,but it still cannot completely replace the traditional thoracotomy .%目的 探讨胸腔镜治疗小儿肺包虫患者的临床疗效.方法 回顾性分析2002年1月至2015年12月在新疆维吾尔自治区人民医院收治的96例接受手术治疗的小儿肺包虫患者的临床资料,其中行胸腔镜手术的50例小儿肺包虫患者作为胸腔镜组,行开胸手术的46例小儿肺包虫患者作为开胸组,比较两组患儿的临床效果.结果 小儿肺包虫患者作为胸腔镜组,行开胸手术的46例小儿肺包虫患者作为开胸组,比较两组患儿的临床效果.结果胸腔镜组患者术中出血量少于开胸组[(10.16±1.80)mL比(19.31±3.27)mL],术后留管时间少于开胸组[(3.28±0.18)d比(5.16±1.62)d](P0.05).结论 胸腔镜手术是治疗小儿肺包虫病安全可行的方法,但是胸腔镜手术不能完全替代传统开胸手术.

摘要： 肺包虫病是犬绦虫的蚴虫在人体肺组织内寄生所致，也是牧业地区常见的人兽共患病，在全身包虫病中的发病率仅次于肝包虫居第二位。肺包虫囊肿较易破裂，破裂后临床及影像表现复杂多样，易致误诊。本文收集经手术病理证实的破裂肺包虫囊肿37例，探讨其影像诊断。