首次非手术治疗颅内梅毒性树胶肿1例并文献复习  

The first nonoperative treatment in patient with syphilitic cerebral gumma:1 case report and review of the literatures

作　　者：丁志良[1] 施辛[2] 阮文华[1] 成之奇 吴刚[1] 霍雷[1] 

机构地区：[1]江苏省苏州市立医院本部脑外科,215002 [2]苏州大学附属第二医院皮肤科

出　　处：《中国现代医药杂志》2010年第11期57-60,共4页Modern Medicine Journal of China

摘　　要：目的探讨梅毒性树胶肿的临床表现、实验室检查、影像学特征,提供早期诊断依据及非手术治疗方法。方法回顾性分析经临床和实验室确诊的1例梅毒性树胶肿患者的有关临床资料,结合文献对其临床表现、诊断及治疗进行探讨。结果患者以头痛为主要症状,血及脑脊液的快速血浆反应素试验(RPR)和梅毒螺旋体明胶抗体试验(TPPA)阳性,脑脊液细胞数及蛋白含量增高,CT及MRI示左额叶占位,诊断为梅毒性树胶肿,经大剂量水剂青霉素治疗后症状消失,实验室及影像学检查恢复正常,随访1年未见复发。结论颅内梅毒性树胶肿罕见,诊断需结合梅毒感染史、临床表现、实验室及影像学检查综合分析,水剂青霉素是目前治疗梅毒性树胶肿的最好选择,疗效满意。脑脊液中细胞计数及蛋白含量是疗效观察的敏感指标,CT或MRI是诊断、鉴别诊断及疗效判断的重要辅助检查。Objective To explore the clinical characteristics,laboratory and imaging manifestations of syphilitic cerebral gumma,and present the evidence of early diagnosis and nonoperative treatment.Methods Retrospectively analysed the clinical data of one cases with syphilitic cerebral gumma,and to investigate the clinical feature,diagnosis and treatment combining with review of the literatures.Results The early chief clinical manifestations of patient was headache.The rapid plasma reagent test（RPR） and treponema pallidum particle assay（TPPA）of the blood serum and the cerebrospinal fluid（CSF） were all positive,CSF examination revealed CSF protein and leukocyte count increase,cranial CT and MRI findings revealed a mass lesion in the front lobe on the left.The patient had a good recover with a large dose and sufficient courses of penicillin monotherapy.The laboratory findings were normal and the gumma disappeared in the MRI scan.The patient was followed-up for one year and the gumma recurrence was not found.Conclusion Syphilitic cerebral gumma is rare.The diagnosis of syphilitic cerebral gumma depends on comprehensive analysis of clinical characteristics,laboratory findings and neuroimages.Penicillin is the best choice for treatment and can get predominant effects.The white cell count and protein of cerebrospinal fluid are important indicators in evaluating the results of syphilitic cerebral gumma treatment,and the CT or MRI scan is the important assistant examination for diagnosis,differential diagnosis and treatment of the disease.

关 键 词：梅毒性树胶肿 诊断 非手术治疗 

分 类 号：R759.1[医药卫生—皮肤病学与性病学]