本文關(guān)鍵詞： 脾臟囊型包蟲(chóng) 繼發(fā)性 臨床特點(diǎn) 診斷 治療　出處：《石河子大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討脾臟囊型包蟲(chóng)病的臨床特點(diǎn),提高臨床診治水平。方法:回顧性分析2007年1月至2016年1月我院收治的經(jīng)外科手術(shù)治療10例確診為脾臟囊型包蟲(chóng)病患者的臨床資料。果:10例患者均長(zhǎng)期生活于囊型包蟲(chóng)病流行區(qū)(中國(guó)新疆),均有犬羊密切接觸史;10例SHC患者中8例既往有囊型包蟲(chóng)病手術(shù)史(1次或多次),2例既往無(wú)外傷手術(shù)史。10例患者中最常見(jiàn)的首發(fā)癥狀為腹痛、腹脹等其它腹部臟器受包蟲(chóng)所累產(chǎn)生的相應(yīng)癥狀,查體多未觸及脾臟腫大。實(shí)驗(yàn)室檢查無(wú)特殊,影像學(xué)檢查提示肝、脾等腹腔多臟器多發(fā)囊性占位,部分臟器影像表現(xiàn)為典型囊型包蟲(chóng)病特征。5例患者行“脾包蟲(chóng)內(nèi)囊摘除+其它部位包蟲(chóng)摘除術(shù)”,4例患者因脾臟多發(fā)包蟲(chóng)且累及脾門(mén)行“脾切除+其它部位包蟲(chóng)摘除術(shù)”,1例患者脾臟包蟲(chóng)囊腫小且有大量鈣化壞死征像而未行手術(shù)治療,僅行“其它部位包蟲(chóng)摘除術(shù)”,10例患者術(shù)后均預(yù)防性口服阿苯達(dá)唑3個(gè)月-半年。1例脾包蟲(chóng)合并門(mén)脈高壓患者行“脾切除+其它部位包蟲(chóng)摘除術(shù)”術(shù)后患者血小板計(jì)數(shù)持續(xù)維持在正常參考值上限及發(fā)生雙側(cè)少量胸腔積液,1例術(shù)后出現(xiàn)粘連性腸梗阻,2例患者術(shù)后發(fā)生雙側(cè)少量胸腔積液,其余6例無(wú)早期術(shù)后并發(fā)癥發(fā)生。隨訪1-3年,患者均未見(jiàn)脾臟包蟲(chóng)再發(fā),預(yù)后良好。結(jié)論:1.脾臟囊型包蟲(chóng)病患病率低,除脾臟受累外,同時(shí)多合并其它臟器包蟲(chóng)。2.有包蟲(chóng)病史再發(fā)脾臟包蟲(chóng)者多為繼發(fā)性脾臟包蟲(chóng)病患者。3.繼發(fā)性脾臟囊型包蟲(chóng)病臨床表現(xiàn)缺乏特異性,常規(guī)血清檢測(cè)對(duì)臨床確診無(wú)特異性意義,初步診斷可結(jié)合脾臟或其它部位典型包蟲(chóng)囊腫影像及病史,確診需術(shù)后病理。4.繼發(fā)性脾包蟲(chóng)臨床以開(kāi)腹手術(shù)聯(lián)合術(shù)后驅(qū)蟲(chóng)治療為宜,可降低再發(fā)風(fēng)險(xiǎn)。
[Abstract]:Objective: to investigate the clinical characteristics of splenic cystic hydatid disease. Methods: the clinical data of 10 cases of splenic cystic hydatid disease diagnosed by surgical treatment from January 2007 to January 2016 were analyzed retrospectively. Type type hydatid disease endemic areas (Xinjiang, China, all have close contact between dogs and sheep). Of the 10 patients with SHC, 8 had a history of cystic hydatidosis one or more times. The most common initial symptom was abdominal pain in 2 patients with no traumatic surgical history, and in 10 patients, abdominal pain was the most common initial symptom. Other abdominal organs, such as abdominal distension, caused by hydatid worms, did not touch splenomegaly. Laboratory examination showed that the liver, spleen and other abdominal organs had multiple cystic space. Some visceral images showed typical cystic hydatidosis in 5 patients with splenic hydatid internal cyst excision of other parts of hydatid cyst and 4 patients with splenic multiple hydatid disease and involvement of splenic hilum with "splenectomy of other parts of hydatid picking." One case of splenic hydatid cyst was small and had a large number of calcified and necrotic signs without surgical treatment. Only "other site hydatid excision" was performed in 10 patients. After operation, albendazole was administered prophylaxis orally for 3 months to half a year. 1 cases of splenic hydatid with portal hypertension were treated with "splenectomy and other site hydatid excision". The count was maintained at the upper limit of the normal reference value and the bilateral pleural effusion occurred in 1 case with adhesive intestinal obstruction and 2 cases with bilateral pleural effusion. There were no early postoperative complications in the other 6 cases. No recurrence of splenic hydatid was found in the patients during the follow-up period of 1-3 years, and the prognosis was good. Conclusion 1. The incidence of splenic cystic hydatidosis is low, except the splenic hydatid disease. At the same time, most of the patients with secondary splenic hydatid disease had history of hydatid disease. 3. The clinical manifestations of secondary splenic cystic hydatid disease were lack of specificity, and routine serum detection had no specific significance for clinical diagnosis. The initial diagnosis can be combined with the imaging and history of typical hydatid cyst in spleen or other parts, and the diagnosis needs postoperative pathology .4.The clinical diagnosis of secondary splenic hydatid cyst is suitable for laparotomy combined with postoperative deworming treatment, which can reduce the risk of recurrence.
【學(xué)位授予單位】：石河子大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R532.32

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