新疆伊犁河谷肝棘球蚴病临床资料分析

Clinical Analysis on Hepatic Hydatid Disease in Yili River Valley

目的 探讨新疆伊犁河谷肝棘球蚴病流行病学特点及临床诊治方法。 方法 对 1993～ 2 0 0 3年伊犁河谷多家医院经手术确诊并治疗的肝棘球蚴病病例进行回顾性分析。 结果 共 2 0 49例肝棘球蚴病患者 ,其中细粒棘球蚴病 1965例占 96% ,泡球蚴病 84例占 4%。所有病例经棘球蚴皮内过敏试验、B超、彩超、X线检查、X线断层照相术 (CT)、磁共振成像术 (MRI)、血清学免疫试验均可确诊。确诊病例经手术治疗 2 0 3 4例占 99 2 %。其中 ,行肝叶切除术、肝棘球蚴外囊膜内完整切除术、肝棘球蚴囊肿外囊外切除术共 3 0 2例占 14 7% ,无术后复发及并发症。术后服药 (吡喹酮、阿苯达唑、阿苯达唑脂质体 ) 75 4例占 3 6 7% ,均有一定疗效。肝棘球蚴病流行病学特点是沿伊犁河谷流行、散布。患者均生活在农牧区 ,均有与牛、羊、狗密切接触史 ,当地各民族人群均有发病 ,女性 112 5例占 5 4%。2 5～ 49岁发病率较高为 982例占 48%。 1993～ 2 0 0 3年发病率呈逐年下降趋势。 结论 肝棘球蚴病是新疆伊犁地区高发病、多发病 ,沿伊犁河谷流行、散布。应进一步加强病畜管理、改良手术治疗方法 ,积累临床经验。

Objective To analyze the clinical diagnosis and treatment of hepatic hydatid disease and its epidemiological characteristics in Yili river valley. Methods Retrospective investigation was carried out on 2 049 cases collected in 1993～2003. Clinical diagnosis was made by ways of intradermal test, serological test, ultrasound, X-ray, CT and/or MRI, majority of them received surgical operation. Results Among the 2 049 cases, cystic hydatidosis occupied 96%( 1 965 / 2 049 ), while 4%(84/ 2 049 ) were alveolar hydatidosis. 99% ( 2 034 / 2 049 ) accepted surgery including hepatolobectomy, endocystomy and hydatidostomy in 302 cases (14 ^7%) without relapses. 754 cases (36 ^7%) received chemotherapy (praziquantel, albendazole) after surgical operation. The disease distributed in agri-pastoral areas along the valley. Local residents from different minorities had a close contact with dogs, 54% of the cases were females and 48% of the cases were in the group of 25-49 years old. The incidence tends to decline in the years. Conclusion Hydatidosis is still an important health problem in the region. Further practices for improving treatment especially surgical intervention and for epidemiological investigation are needed.