消化内镜诊治寄生虫感染614例分析  

Analysis of 614 cases of parasite infection diagnosed and treated by gastrointestinal endoscope

作　　者：温春虹 曾智聪 刘将[1] 蔡艺玲[1] 张帅[1] 张鸣青[1] Chun-hong Wen;Zhi-cong Zeng;Jiang Liu;Yi-ling Cai;Shuai Zhang;Ming-qing Zhang(Department of Gastroenterology,the 909th Hospital of Joint Logistics Support Force(The Affiliated Southeast Hospital of Xiamen University),Zhangzhou,Fujian 363000,China)

机构地区：[1]联勤保障部队第909医院(厦门大学附属东南医院)消化内科

出　　处：《中国内镜杂志》2019年第12期71-75,共5页China Journal of Endoscopy

基　　金：南京军区医学科技创新重点项目(No:15ZD026);青年苗圃基金(No:15Y005)

摘　　要：目的分析消化内镜检出寄生虫感染的情况,并探讨消化内镜在寄生虫感染诊治中的应用。方法回顾性分析2004年1月-2018年12月在联勤保障部队第九O九医院消化内镜中心诊治中发现的寄生虫感染患者的临床资料,统计寄生虫的种类,分析应用消化内镜诊断寄生虫的准确性及辅助治疗寄生虫的临床效果。结果经消化内镜诊断寄生虫感染共614例。其中,胃镜检出368例(60.0%),肠镜检出242例(39.4%),小肠镜检出2例(0.3%),胶囊内镜检出2例(0.3%)。感染部位最常见的为十二指肠(356例)和回盲部(185例)。消化内镜下可诊断钩虫、鞭虫、蛔虫、蛲虫,还可用于活检找血吸虫虫卵进行辅助诊断。初始诊断中,301例(49.0%)诊断明确且准确,293例(47.7%)未明确诊断,20例(3.3%)诊断错误。内镜诊断的灵敏性明显高于粪便虫卵检查。内镜辅助治疗寄生虫感染36例,35例采取活检钳直接夹除寄生虫的方式治疗,1例采取经内镜途径3次灌药的方式(大量钩虫感染)治疗,均取得满意的辅助治疗效果。结论内镜检查时可根据长度、颜色和其他特征,对常见的消化道寄生虫种类作出较为准确的判断,少数感染的情况下可直接钳取治疗。消化内镜可在寄生虫的诊治方面发挥更加积极的作用。Objective To explore the role of gastrointestinal endoscope in the diagnosis and treatment of parasite infection in digestive tract.Methods A retrospective analysis of the records of patients diagnosed with parasite infection by gastrointestinal endoscopy from January 2004 to December 2018 was conducted.Parasite species was verified by reviewing records.Application of gastrointestinal endoscope in the treatment of parasite infection was evaluated.Results There were 614 patients found by endoscope to be with parasite infection during the 15 years.60.0%of them(368 patients)were diagnosed by gastroendoscopy,while 39.4%of them(242 patients)were detected by colonoscopy.Other ways contributed to the discovery of parasite infection were enteroscopy and capsule endoscopy,each of them discovered 2 patients infected with parasites.Duodenum was the most common location of infection(356 cases),followed by cecum(185 cases).Digestive endoscopy could be employed to diagnose hookworm,whipworm,roundworm and pinworm infection,and could assist the diagnosis of schistosomiasis through biopsy of sigmoid colon to examine Schistosoma eggs.In terms of parasite species,only 49.0%were correctly diagnosed,while 47.7%were lack of exact diagnosis and 3.3%were misdiagnosed.The sensitivity of endoscopy in diagnosis of parasite infection was significantly higher than that of stool ova and parasites test.There were two ways for endoscope system to treat parasite infections,removing parasites by biopsy forceps and getting rid of them by perfusing anthelmintic drugs throughout small intestine in three times,both of which were turned out to be effective.Conclusion The definite species of some parasites may be determined by endoscopy according to its length,color and other observable characteristic.Patients with mild infection could be dewormed by endoscope system.Gastrointestinal endoscope might play a more positive role in the diagnosis and treatment of parasite infection.

关 键 词：消化道寄生虫感染 内镜检查 诊断准确性 钩虫 鞭虫 

分 类 号：R53[医药卫生—内科学]