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目的探讨脑型血吸虫病的临床诊断和治疗方法。方法选择解放军171医院1989-2013年收治的166例脑型血吸虫病患者的临床和影像学资料、诊断及治疗方法进行分析。结果 166例脑型血吸虫病患者中,根据临床表现、病原学、免疫学结合CT、MRI辅助检查确诊156例,其中病理检查确诊74例,诊断性治疗确诊10例。102例患者行口服吡喹酮40 mg/kg治疗,于14~36 d临床症状好转后出院。64例行开颅手术,术后辅以口服吡喹酮抗血吸虫治疗。其中,48例术后恢复良好,7例肢体瘫痪加重,4例肢体发麻加重,11例术后仍有癫痫发作,无手术死亡病例。随访81例,66例症状及体征消失,7例肢体轻瘫但生活能自理,5例生活不能自理,3例死于其他原因。结论颅脑影像学和实验室专项检测对脑型血吸虫病诊断有重要价值。脑型血吸虫病治疗应根据患者具体情况采取内科治疗或外科手术治疗。
Objective To investigate the clinical diagnosis and treatment of cerebral schistosomiasis. Methods The clinical and imaging data, diagnosis and treatment of 166 schistosomiasis patients from 1989 to 2013 in the People’s Liberation Army 171 Hospital were analyzed. Results Among the 166 cases of schistosomiasis, 156 cases were diagnosed according to the clinical manifestations, etiology, immunology and CT and MRI. Among them, 74 cases were diagnosed by pathology and 10 cases were diagnosed by diagnostic method. 102 patients were treated with oral praziquantel 40 mg / kg, and their symptoms were discharged after 14 ~ 36 days. 64 cases of craniotomy, supplemented with oral praziquantel anti-schistosome treatment. Among them, 48 cases recovered well, 7 cases of limb paralysis aggravated, 4 cases of aggravating limbs, 11 cases still have epileptic seizures, no surgical deaths. Follow-up 81 cases, 66 cases of symptoms and signs disappeared, 7 cases of limb paralysis but life can take care of themselves, 5 cases of life can not take care of themselves, 3 patients died of other reasons. Conclusion Brain imaging and laboratory tests are valuable for the diagnosis of cerebral schistosomiasis. Brain schistosomiasis treatment should be based on the specific circumstances of patients with medical treatment or surgical treatment.