脑泡型包虫病的诊治分析(附29例报道)

Diagnosis and treatment of cerebral alveolar echinococcosis(report of 29 cases and literature review)

目的 探讨脑泡型包虫病(CAE)的临床特征、治疗方法及其疗效。方法 回顾性分析2014年6月至2022年9月收治的29例CAE的病例资料。所有病人均接受抗虫药物治疗,其中一期手术切除9例,分期手术切除4例。出院后随访6~48个月,平均13.8个月。结果 手术治疗的13例中,10例病灶全切除,3例次全切;末次随访KPS评分[(76.2±13.5)分]较术前[(52.3±10.6)分]明显提高(P<0.05)。仅接受抗虫药物治疗16例中,死亡4例,失访3例;末次随访KPS评分[(53.8±11.5)分]与术前[(56.9±12.4)分]无统计学差异(P>0.05)。结论 CAE多见于有牧区生活史的成年人,结合病史、血清学检查和影像检查可做到早期诊断。目前,CAE尚无特效抗虫药,一期或分期手术完整切除病灶可改善病人预后,提高病人生活质量。

Objective To investigate the clinical features,and the treatment methods and their effectiveness of patients with cerebral alveolar echinococcosis(CAE).Methods The clinical data of 29 patients with CAE who were admitted to our hospital from June 2014 to September 2022 were retrospectively analyzed.All the patients were treated with antiparasitic drugs(albendazole).Nine patients received one-stage operation for resection of all the intracranial lesions and 4 received staged operation for resection of all the intracranail lesions.The follow-up ranged from 6 months to 48 months after discharge,with an average of 13.8 months.Results Of 13 patients undergoing operation,total resection of all the lesions was achieved in 10 patients and subtotal resection in 3;the KPS score[(76.2±13.5)points]at the last follow-up was significantly higher than that[(52.3±10.6)]before the operation(P<0.05).Of 16 patients treated with anti-antiparasitic drugs only,4 died and 3 were lost to follow-up;there was no significant difference in the KPS score at the last follow-up[(53.8±11.5)points]with that before the operation[(56.9±12.4)points;P>0.05].Conclusions CAE is more common in adults with pastoral life history,and early diagnosis can be made by combination of medical history,serological examination and imaging.At present,CAE has no specific anti-antiparasitic drugs,and complete resection of lesions by one-stage or staged operations can improve the prognoses and the quality of life of patients with CAE.