曼氏迭宫绦虫裂头蚴活体供肾脂肪囊寄生1例

Sparganosis mansoni in adipose capsule of the living related donor in one case

通过现有病例结合相关文献分析曼氏裂头蚴在供肾的寄生特征。49岁女性自愿捐献一肾脏给儿子,健康评估结果符合活体捐献肾脏标准。供肾切取后,修肾时发现供肾腹侧面脂肪囊内近肾门处有一长条形囊肿,切开囊肿,从中抽出一条乳白色活动的带状虫体,经鉴定为曼氏迭宫绦虫裂头蚴(活体)。囊肿病理检查为肉芽肿性炎症,并中性粒细胞及嗜酸粒细胞浸润。术后供、受者均服用吡喹酮治疗,3个月内多次粪检均未见节片和虫卵排出,也无任何不适症状。供者感染的方式和途径可能是食用未熟的转续宿主肉类或误食受感染的剑水蚤。肾移植前供、受者应进行曼氏裂头蚴等寄生虫感染的检查。由于寄生于肾脏的裂头蚴由于无明显症状,很少被发现,从粪便中查到本虫虫卵为诊断曼氏迭宫绦虫病的依据,询问病史有一定参考价值,血中嗜酸粒细胞增多常提示慢性寄生虫感染,必要时还可以进行动物感染实验,还可以用裂头蚴抗原进行各种免疫学试验可为该病提供免疫学辅助诊断依据。确诊主要靠手术或病理组织检查取得虫体即可确诊并治疗。综合采用CT检查和MRI检查等放射影像技术对供肾裂头蚴病有一定的鉴别诊断价值。

Parasitism characteristics of spirometra mansoni sparganum in the living donor kidney are analyzed by present cases and relevant literatures.A female aged 49 years voluntarily donated a kidney to her son.Results of healthy evaluation were accorded with the standards of living donor kidney.During repairing kidney,a sliver cyst was found in the adipose capsule on the kidney ventral surface,near to the renal hilum.The cyst was incised,and a ivory white girdle-shaped worm was obtained.After identification,the worm was identified spirometra mansoni sparganum（living body）.Pathological examination showed that the cyst developed granulomatous inflammation,combined with neutrophil and eosinophilic granulocyte infltration.Following surgery,the donor and recipient were treated with praziquantel.No proglottid or worm ovum was detected by dung detection within 3 months,without any discomfortable symptom.The infection mode and pathway may be by eating unmatured paratenic host meat or infected cyclops.The donor and recipient should be examined for parasitic infection of sparganosis mansoni prior to transplantation.No significant symptom could be detected following parasitism of sparganosis mansoni in the kidney,so it was seldom found.Worm ovum was examined in feces,which could be the evidence for sparganosis mansoni and for case history inquisition.Eosinophilia in the blood always indicated that chronic parasitic infection.Zoogenetic infection test could be tested when necessary.Sparganum antigen could be used for various immunological tests,which could provide evidence for auxiliary diagnosis of immunology.The diagnosis was usually confirmed by obtaining a polypide by surgery or histological examination.CT scanning and magnetic resonance imaging have diagnostic value of renal sparganosis mansoni.