肝泡型包虫病脑转移11例治疗分析  

Treatment of combined hepatic with cerebral alveolar echinococcosis in 11 cases

作　　者：阿地来•阿布来提 张新峰 尼加提•塔西甫拉提 杨学安 郭强 吐尔干艾力•阿吉 邵英梅 阿依甫汗•阿汗 Adilai Abulaiti;Zhang Xinfeng;Nijiati Taxifulati;Yang Xuean;Guo Qiang;Tuerganaili Aji;Shao Yingmei;Ayifuhan Ahan(Department of Hepatobiliary and Hydatid Diseases,Digestive and Vascular Surgery Center,First Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,China)

机构地区：[1]新疆医科大学第一附属医院消化血管外科中心肝胆包虫外科,乌鲁木齐830011

出　　处：《中华肝胆外科杂志》2020年第9期674-677,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：新疆维吾尔自治区自然科学基金(2018D01C220)。

摘　　要：目的分析肝泡型包虫病脑转移患者的治疗方法及其效果。方法回顾分析2014年1月至2019年12月在新疆医科大学第一附属医院住院治疗的11例肝泡型包虫病脑转移患者资料,男性7例,女性4例,年龄范围19~49岁,平均34岁。11例患者中7例采用手术联合药物治疗,4例仅为药物治疗。分析患者的治疗方法及随访疗效。结果2例仅行肝部手术患者,术后规律口服抗包虫药物,随访期间病情稳定。3例仅行脑部手术患者,术后随访1~3年,随访期间1例出现肺炎并肺不张,1例出现腹水、黄疸、体力下降,另1例病情稳定,生活能自理。2例联合行肝部分切除术和脑包虫切除术患者,其中1例多次行脑包虫切除术,至今随访5年,生活不能自理,在家休养。另1例,随访3年病情稳定,健在并能自理。4例单纯口服阿苯达唑脂质体治疗,其中1例随访3年病情平稳,1例出现腹水,1例出现体重减轻、体力下降、肢体水肿,另1例出现胸腔积液、盆腔积液、肺炎等,均采取对症支持治疗后好转,生命体征平稳,健在。结论肝泡型包虫病脑转移的治疗仍然以手术为主,术后予以抗包虫药物治疗,多数患者预后较差。原则上先行神经外科手术,再行肝、肺、脾等器官包虫手术。ObjectiveTo analyze the treatment and the impact of brain metastases on patients with hepatic alveolar hydatid disease.MethodsThe data of 11 patients with hepatic alveolar hydatidosis with brain metastases treated at the First Affiliated Hospital of Xinjiang Medical University from January 2014 to December 2019 were retrospectively analyzed.There were 7 males and 4 females.The age range was 19~49 years,with an average of 34 years.Of 11 patients,7 were treated with surgery combined with drugs and 4 with drugs only.Analyze the treatment and results of patients.ResultsOf the 7 patients who were treated with surgery and drugs,2 patients underwent hepatectomy.They were treated with regular postoperative oral medication and were well on follow-up.Three patients underwent only brain surgery.On follow-up from 1 to 3 years,one patient developed pneumonia with atelectasis,another patient developed ascites and jaundice with physical decline.The third patient was stable and had an independent life.Two patients underwent partial hepatectomy and hydatidectomy,with one patient requiring repeated hydatidectomies.On follow-up for one of these 2 patients for 5 years,the patient was home bound and could not take care of himself.The other patient was followed up for 3 years and was stable,alive and able of self-care.Four patients were treated with albendazole liposome,including one patient who developed ascites,a second one with weight loss,physical decline,limb edema and a third one with pleural effusion,pelvic effusion and pneumonia.These patients were still alive with improvement of symptoms on supportive treatment.ConclusionThe treatment of hepatic alveolar hydatidosis with brain metastases is still mainly surgery and anti-hydatid drugs.The prognosis of most patients was poor.The surgical principle is neurosurgery first,followed by surgery on liver,lung,spleen and other organs involved by hydatid disease.

关 键 词：棘球蚴病 肝 脑泡型包虫病 手术联合药物治疗 单纯药物治疗 

分 类 号：R657.3[医药卫生—外科学]