脑裂头蚴病的诊断及手术取出活虫的经验

Experience in diagnosis and successful removal of live worms for cerebral echinococcosis

目的探讨脑裂头蚴病的临床、影像学特点和实验室检查等,并分析手术取出活虫的经验。方法回顾性分析广东三九脑科医院神经外科2001年1月—2017年12月收治并经手术取出裂头蚴活体的36例患者的临床表现、影像学检查、血清抗体检查和随访结果。结果本组36例患者均有不洁的饮食史或蛙肉、蛇肉贴敷伤口史,共行37次手术,取出活虫37条,长度1.5~21 cm不等。所有患者头部CT及MRI检查显示脑白质均有变性和水肿,CT有或不伴有钙化,MRI增强扫描有典型的“隧道征”和“串珠样”强化。术后MRI复查显示,35例患者原强化灶消失,1例患者原强化灶未消失且在术区后方出现新的强化影。术前血清学抗体检查示32例患者(88.9%)为阳性或弱阳性。33例术前有癫痫发作的患者于术后均规律口服抗癫痫药物2年,31例患者(86.1%)再无癫痫发作。本组患者随访3个月~5年不等,失访患者6例。结论脑裂头蚴病流行与不洁的饮食习惯有关,裂头蚴可于脑内长期存活并游走,平均移动速度可能为0.74 cm/月。诊断主要根据病史、临床表现、影像学特点和实验室检查,神经外科手术应用立体定向或神经导航定位可有效地取出活虫,治疗效果满意。

Objective To explore the clinical features,imaging features and laboratory examinations of cerebral echinococcosis,and analyze the experience of successful removal of live worms by surgery.Methods The clinical data of 36 patients with cerebral sparganosis who were treated at Department of Neurosurgery,Guangdong 999 Brain Hospital between 2001 and 2017 were analyzed retrospectively.Results All 36 patients had an unclean diet history,37 operations were performed in 36 patients,37 live worms were removed,and the length was between 1.5-21 cm.All patients with CT and MR examination showed that the white matter had degeneration and edema,CT had or did not have calcification,and after the enhancement of MR there was a typical“tunnel sign”and“string-of-beads”.MR after operation showed that the primary foci disappeared in 35 patients,1 case did not disappear and appear in the rear of the operation area.Preoperative serological antibody test showed that 32 cases(88.9%)were positive or weak positive.33 cases of epileptic seizures before operation had regular oral antiepileptic drugs for 2 years,and 31 cases(86.1%)had no seizures.Conclusions The disease is related to unclean eating habits.The cercariae can survive and move in the brain for a long time,and the average moving speed may be 0.74 cm per month.The diagnosis of the disease is mainly based on the clinical features,imaging features and laboratory examinations.Application of stereotactic or neuronavigation is effective to remove the living worms.