安徽省外科救治晚期血吸虫病270例调查分析与随访

A follow-up investigation on 270 cases of advanced schistosomiasis with surgical treatment in Anhui province

目的了解分析全省二年来外科救治晚期血吸虫病人的临床特征、手术方式及其转归,为晚期血吸虫病的救治提供依据和经验。方法按照国家外科救治晚期血吸虫病统一要求,查阅、收集全省13个定点医院2005～2006年晚期血吸虫病外科住院病案,对外科手术住院病例收集相关信息、填写统一的个案调查表,进行分析。结果13个定点医院共调查270例晚期血吸虫病外科手术治疗住院病例,其中东至、宣州二县(区)有164例,占60.74%。晚血病例中,女性多于男性,男女之比为1∶1.23;晚血病人患病的平均年龄为47.07岁,50岁以上老年患者所占的比例达31.28%,15岁以下儿童1例,占0.37%;农民是职业分布中最主要的人群,占98.15%。对手术病例临床资料进行分析,平均晚血发生时间和平均晚血持续未治时间分别为13.80年和4.92年;晚血患者的临床分型以单纯巨脾型为多,占82.59%,巨脾、腹水混合型病例次之,占17.41%;施行的外科手术方式以单纯脾切除术最多,占手术总病例数的87.78%;晚血患者合并有乙肝感染者占12.59%;手术治疗期间可出现严重并发症,如大出血、膈下积液等,甚至导致死亡,其手术病死率为0.74%;有139例晚血患者的医疗费全部由国家晚血专项救助经费报销,占全部手术病例的51.48%;术后随访,晚血病人症状、体征明显改善的达98.88%,劳动能力恢复者达50.75%。结论通过调查,对我省不同疫区、不同人群的晚期血吸虫病分布情况及其危害有了更深的了解,从而为进一步指导全省有效救治晚期血吸虫病提供重要的参考依据。

Objective To understand the clinical feature, operational ways, and turnover of advanced schistosomiasis for surgical treatment in Anhui Province, and provide experience for the treatment of advanced schistosomiasis. Methods The medical record and other related data were collected and analyzed from 13 fixed-point hospitals in Anhui Province from 2005 to 2006, where the patients were administered standard surgical treatment according to the national technique guidelines for surgical treatment of advanced schistosomiasis. Results A total of 270 cases in the 13 hospitals were investigated, and 60.74 percentage with 164 cases were in Dongzhi county and Xuancheng county. All the cases, the female cases were more than male cases, the proportion was 1 to 1.23. The average age of the patients was 47.07 years old, and the patients over 50 years old accounted for 31.28%, and only one patient was less than 15 years old. The majority was peasants which accounting for 98.15%. The average duration for the development of advanced schistosomiasis was 13.80 years, and the average time for the cases delayed to treat was 4.92 yeats. Of the 270 cases 223 （82.59%） were clinically classified as purely megalosplenialy type, and the others （17.41%） were mixed type （megalosplenia and ascites）. Some patients （12.59%） were co-infected with hepatitis B virus. A few serious complications happened during the surgical treatment. 2 patients died with the death rate of 0.74%. The cost of 139 cases with the proportion of 51.48% was covered by the national special fund for advanced schistosomiasis treatment. Following up one month after treatment, symptom and physical sign improved in almost all treated patients （98.88%）, and about 50.75% patients restored their physical working capacity. Conclusion There would be further understand the distribution and the damage of advanced schistosomiasis, and provide important evidence on the treatment of advanced schistosomiasis effectively in Anhui province.