胸膜曼氏裂头蚴病一例并文献复习

Pleural sparganosis： report of a case and review of the literature

目的 探讨胸膜曼氏裂头蚴病的临床特点,提高临床医生对本病的认识.方法 报道温州医科大学附属第一医院收治的1例胸膜曼氏裂头蚴确诊病例的临床表现、诊断治疗经过和转归,并以“曼氏跌宫绦虫”、“裂头蚴”、“裂头蚴与胸腔”、“裂头蚴与胸膜”为检索词检索维普数据库、万方数据库和中国学术期刊网络出版总库;以“sparganosis”为检索词检索PubMed数据库.结果 患者男,38岁,因“右胸腔积液”入院.依据血液和胸腔积液嗜酸粒细胞增高、血清抗曼氏裂头蚴抗体阳性、内科胸腔镜活检的胸膜组织见寄生虫虫体而确诊为胸膜曼裂头蚴病.吡喹酮75 mg· kg-1 ·d-1治疗3d后痊愈.PubMed、万方数据库、维普数据库、中国学术期刊网络出版总库共检索到5篇胸膜曼氏裂头蚴病相关文献,共6例患者.5例X线胸部平片或CT见胸腔积液,5例血清曼氏裂头蚴抗体阳性,3例胸膜组织病理检查到寄生虫虫体.2例行外科胸腔镜检查.6例均服用吡喹酮后痊愈.结论 胸膜裂头蚴属于罕见病,临床表现无特异性.血液和胸腔积液中嗜酸粒细胞增高的患者应行血清曼氏裂头蚴抗体检查,以避免误诊.内科胸腔镜在胸膜裂头蚴病的诊断中具有重要价值.

Objective To improve the understanding of pleural sparganosis by analyzing a clinical case and literature review.Methods The clinical data of a patient with pleural sparganosis diagnosed by immunoserology and pathology was analyzed.The data of 6 cases from literature reports regarding pleural sparganosis were reviewed through database including PubMed,VIP,Wanfang and China Knowledge Resource Integrated Database.The clinical characteristics,diagnosis and treatment of the 7 cases were summarized and analyzed.Results A 38-year-old man was admitted to our hospital with right pleural effusion,and received the final diagnosis of pleural sparganosis according to increase of eosinophils in blood and plural effusion,positive sparganum-mansoni antibody in serum,and parasite bodies in pleural tissues biopsied with medical thoracoscopy.The patient was treated successfully with consecutive three-day doses of praziquantel（75 mg · kg-1 · d-1）.The documents reported 6 cases of pleural sparganosis on the database of PubMed,Wafang,VIP and China Knowledge Resource Integrated Database.Pleural effusion was found in 5 cases by chest radiograph or CT.Serum sparganum-mansoni antibody assays were strongly positive in 5 cases,and sparganosis bodies were confirmed by pleural histological findings in 3 cases.Two patients received video-assisted thoracic surgery examinations.Six patients recovered with the treatment of praziquantel.Conclusions Pleural sparganosis is a rare disease.Patients with increase of eosinophils in blood and pleural effusion should receive serum sparganum-mansoni antibody test to avoid misdiagnosis of pleural sparganosis.Medical thoracoscopy plays an important role in the diagnosis of pleural sparganosis.