埃及血吸虫病误诊为膀胱肿瘤两例报道并文献复习  

Misdiagnose Schistosomiasis Haematobia as Bladder Neoplasms: Two Cases Report and Literature Review

作　　者：莫利才[1] 蔡仙国[1] 王秋鹏[2] 陈柏康[1] 郑巧飞[3] 褚邦勇[3] 俞洪元[1] 

机构地区：[1]浙江省台州医院泌尿外科,浙江省临海市317000 [2]浙江省台州医院病理科,浙江省临海市317000 [3]浙江省台州医院检验科,浙江省临海市317000

出　　处：《中国全科医学》2017年第8期1005-1008,共4页Chinese General Practice

摘　　要：目的探讨埃及血吸虫病的流行病学、临床特征及治疗方法,避免误诊。方法回顾性分析浙江省台州医院2016年5月收治的2例埃及血吸虫病患者的临床资料,并复习相关文献。结果患者1,男,53岁,因劳务输出至非洲尼日利亚工作,2016年4月回国。主诉间歇性无痛性终末血尿1年。查体无特殊。泌尿系CT检查:右侧输尿管及右肾积水,膀胱壁增厚,考虑膀胱肿瘤。B超示:膀胱壁增厚。血常规示:嗜酸粒细胞计数升高,嗜酸粒细胞分数明显升高。行膀胱镜检查+活检术,考虑尿路上皮增生伴亚急性炎及寄生虫卵(血吸虫卵首先考虑);尿沉渣镜检确诊后放置输尿管D-J管。患者2,男,52岁,与患者1同期去非洲工作,同期回国。主诉:无痛性间歇性血尿1个月。查体无特殊,B超、泌尿系CT均表现为膀胱壁增厚,未见肾积水。行膀胱镜检查+活检术,考虑嗜酸性膀胱炎,未见虫卵;尿沉渣镜检确诊。2例患者尿中均发现有尾刺的虫卵确诊,口服吡喹酮1个疗程,1周后复查尿沉渣镜检,均未见虫卵。结论在诊治有血尿症状的援非归国人员时,应结合流行病学资料,避免误诊,结合吡喹酮抗血吸虫药物化疗,一般预后良好。Objective To discuss the epidemiology,clinical features and treatment methods of schistosomiasis haematobia and avoid misdiagnosis. Methods The clinical data of two patients with schistosomiasis haematobia who were admitted into Taizhou Hospital of Zhejiang Province in May 2016 were retrospectively analyzed,and a literature review was also made. Results The first patient,male,53 years old,worked in Africa Nigeria due to export of labor service and did not came back until April 2016. The patient reported a painless intermittent terminal hematuria for one year. There was no obvious abnormality in the physical examination. CT examination of the urinary system demonstrated right hydroureterosis and right hydronephrosis,thickened bladder wall,and bladder neoplasm was considered. B ultrasonic test presented thickened bladder wall. Blood routine test showed increased eosinophilic granulocyte count and obviously increased eosinophilic granulocyte fraction. Cystoscopy and biopsy were carried out,and urothelial hyperplasia combined with subacute inflammation（ schistosoma egg was firstly considered）; ureter D- J tube was indwelled after a definite diagnosis with urinary sediments examination. The second patient,a 52- year- old man,went to work in Africa over and went back at the same period as the first patient. The patient reported a painless intermittent hematuria for one month. There was no obvious abnormality in the physical examination.B ultrasonic test and CT examination of the urinary system showed thickened bladder wall and no hydronephrosis. Cystoscopy and biopsy were carried out,eosinophilic cystitis was considered and no eggs were found; a definite diagnosis was made by urinary sediments examination. The caudal spine of schistosomiasis haematobia eggs were shown in the urine of the two cases. After one course of treatment with praziquantel,no eggs were found in the next- week urinary sediment reexamination. Conclusion In diagnosis and treatment of hematuria returnees who aided Africa,we should take epidemiolo

关 键 词：埃及血吸虫病 膀胱肿瘤 误诊 病例报告 

分 类 号：R532.21[医药卫生—内科学]