骶骨包虫病的临床诊断及治疗分析

DIAGNOSIS AND TREATMENT OF SACRUM ECHINOCOCCOSIS DISEASE

目的探讨骶骨包虫病的临床特点,为临床诊断和治疗提供依据。方法回顾分析1999年7月-2010年8月收治的14例骶骨包虫病患者临床资料。男6例,女8例;年龄16～58岁,平均28.7岁。病程6个月～11年,中位病程5.7年。其中12例来自畜牧区或有明显犬、羊密切接触史;12例有肺包虫或肝包虫病病史。主要临床症状为腰骶部及双下肢疼痛,一侧或双侧下肢及会阴部感觉减退,逐渐出现双下肢活动及大小便功能障碍、排尿无力等神经损害表现。影像学检查示多囊性骨质破坏。10例行包虫囊液皮内Casoni试验,其中8例呈阳性,2例呈阴性;4例行包虫病8项免疫血清学检查均为阳性。所有患者彻底清除病灶后,采用自体骨、同种异体骨、人工骨或骨水泥修复缺损。术后常规使用阿苯达唑,持续3个月预防复发。结果术后切口均Ⅰ期愈合,无相关并发症发生。术后14例均获随访,随访时间6个月～11年,中位时间5.7年,患者术前临床症状均缓解。8例于术后6个月～3年复发,其中5例行3次清创手术,1例行5次清创手术,2例行病灶边缘切除联合高速磨钻清理;术后未见复发,症状均不同程度缓解。患者术后均未出现包虫病局部种植或远处播散。结论骶骨包虫病临床症状不典型,易误诊、漏诊,结合MRI检查有助于骶骨包虫病的诊断,血清学检查是诊断骶骨包虫病的主要方法,手术是最主要的治疗方法。

Objective To study the clinical characteristics of sacrum echinococcosis disease so as to provide a basis for its diagnosis and treatment.Methods Between July 1999 and August 2010,14 cases of sacrum echinococcosis disease were treated and the clinical data were analysed retrospectively.There were 6 males and 8 females with an average age of 28.7 years（range,16-58 years）.The median disease duration was 5.7 years（range,6 months to 11 years）.Twelve cases came from cattle area or had a history of close contact with dogs and sheep;12 patients had a history of lung or liver hydatid disease.The main clinical symptoms were lumbosacral and lower extremity pain,one or both lower extremities and perineal hypoesthesia,the gradual dysfunction of both lower extremities and neurogenic bladder and bowel,and decreased force of urination.The imaging examination showed multicystic bone erosion.The Casoni test was performed in 10 cases and the results were positive in 8 cases.The eight immunoserology markers of hydatidosis were detected in 4 cases,and the results were all positive.After entire debridement of the focus,defects were repaired with autogenous bone,allogeneic bone,artificial bone,or bone cement,and then albendazole was used as a routine treatment for 3 months.Results Incisions healed by first intention,and no complication occurred.All patients were followed up 6 months to 11 years with a median time of 5.7 years.The preoperative clinical symptoms were relieved.Eight cases recurred at 6 months to 3 years after operation;after debridement（3 times in 5 and 5 times in 1） and the lesions marginal resection with a high-speed burr（2 cases）,the symptoms were relieved in different degrees without recurrence.No hydatid disease occurred and spreaded.Conclusion The clinical manifestation of sacrum is not typical,which is easy to be misdiagnosed.MRI is helpful to diagnosis sacrum echinococcosis disease;serological examination is the major method of identification diagnosis,and surgery is the main treatment method.