166例脑型血吸虫病的诊断与治疗  

Diagnosis and treatment of cerebral schistosomiasis:a report of 166 cases

作　　者：祝斐[1] 黄新[1] 吴明[1] 金卫星[1] 颉奎[1] 

机构地区：[1]解放军171医院神经外科

出　　处：《中国血吸虫病防治杂志》2014年第6期695-696,共2页Chinese Journal of Schistosomiasis Control

摘　　要：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 discuss the clinical features,diagnosis and treatment of cerebral schistosomiasis. Methods A total of 166 patients with cerebral schistosomiasis were treated,and their clinical data were collected and analyzed retrospectively.Results In 166 cases of cerebral schistosomiasis,the confirmative diagnoses of 156 cases were diagnosed according to the clinical manifestation,etiology,immunology and auxiliary examination（CT、MRI）.In among,74 cases were confirmed by pathological examination,10 cases were diagnosed through to the diagnostic treatment. Totally 102 patients received the oral medication of praziquantel,and they all improved and discharged 14-16 days later;64 patients received the craniotomy and praziquantel medication after the operation,and 48 patients significantly improved,others did not improve or aggravated. There was no operative mortality. Conclusions Neuroimaging and laboratory tests are valuable in the diagnosis of cerebral schistosomiasis. The praziquantel treatment is selected firstly when the diagnosis was established. However,in the case of serious intracranial hypertension,intractable epilepsy and praziquantel treatment fails,the surgical treatment is required.

关 键 词：脑型血吸虫病 诊断 治疗 

分 类 号：R532.21[医药卫生—内科学]