小儿急性血肿型肺吸虫脑病的外科治疗

Surgical management of acute cerebral paragonimiasis （intracerebral hemotoma type）in children

目的分析小儿急性血肿型肺吸虫脑病的临床特点和诊治方法，探讨该型与其他类型的区别。方法回顾性分析16例急性血肿型肺吸虫脑病患儿的临床特点、诊断方法和治疗效果。结果16例患儿均有高颅压症状，惊厥发作5例，肢体偏瘫或单瘫4例，合并肺部症状4例；流行病学史阳性14例；全部病例肺吸虫抗体检测阳性；CT检查发现单纯脑内血肿12例，伴蛛网膜下腔出血3例，伴脑梗塞1例，血肿以额叶、顶叶为主。手术开颅清除血肿11例，非手术治疗5例，所有病例均口服吡喹酮治疗4～6个疗程，随访2个月至2年，预后良好。结论小儿急性血肿型肺吸虫脑病与其他类型有较大差别，病程更短、病情更为危重；影像学检查易出现误诊、漏诊；治疗上更倾向于积极手术；规范治疗预后更好。

Objective To analysis the clinical characteristics, diagnosis and therapy of acute cerebral paragonimiasis （intracerebral hemotoma type） in children, and explore the difference between this type and other types. Methods Clinical data from 16 patients with acute cerebral paragonimiasis （intracerebral hemotoma type） were retrospectively analyzed. Results All the patients presented symptom of high intracranial pressure, among them 5 cases were associated with convulsion seizure, hemiparalysis or monoplegia was seen in 4 cases and pulmonary symptom in 4 cases; 14 cases of patients had history of eating omophagia crab or drinking pestilence water; positive blood paragonimus antibodies was found in all cases; intracerebral hemotoma were found in 12 cases via CT scanning, hemotoma associated with subarachnoid hemorrhage in 3 cases and cerebral infarction in 1 case. Most hemotoma located in frontal lobe and parietal lobe. Hematoma evacuation was carried out in 11 cases, remains undertook the conservative therapy. The praziquantel was orally administered for 4-6 courses and all patients were followed up for 2 months to 2 years. Better prognosis was seen in them. Conclusions There is significant difference between acute intracerebral hemotoma type and other types in children cerebral paragonimiasis, the former one has shorter course of disease and present more severe, are easy to be misdiagnosed through imaging examination, aggressive surgical treatment and standardized drug therapy are needed to achieve better therapeutic efficacy and prognosis.