摘要
目的探讨手术治疗脑裂头蚴病的经验并分析影响活虫取出的相关因素。方法回顾性收集自2001年1月至2017年12月于广东三九脑科医院神经外科行手术治疗的49例脑裂头蚴病患者的临床资料,总结分析治疗经验,并根据是否取出活虫将患者分为活虫取出组和活虫未取出组,比较2组间相关资料的差异。结果49例患者中共取出活虫36条,其中1例于同一病灶内取出2条活虫。45例术前有癫痫发作的患者中39例术后再无癫痫发作(EngelⅠ级)。复查MRI显示39例患者的病灶强化影消失,脑内未见新发病灶;另有2例的原病灶强化影消失,但在病灶后方出现新发病灶,其中1例经再次手术于原病灶对侧颞叶取出活虫,1例继续随访观察。所有患者术后未出现新发出血、梗死,无脑膜炎发生。统计分析发现,活虫取出组(n=35)与活虫未取出组(n=14)间发现病变至手术的时间及病灶部位差异均有统计学意义(P<0.05)。结论手术治疗脑裂头蚴病安全有效。发现病灶后应尽早手术治疗,缩短发现病变至手术的时间,以防止虫体移位;同时需结合病灶部位选择具体的手术方案和手术时机,以提高活虫取出率及降低手术并发症发生率,必要时可再次手术治疗。
Objective To discuss the experience of surgical treatment for cerebral sparganosis and analyze the factors affecting the removal of live worms. Methods A retrospective analysis was performed on clinical data and treatment experience of 49 patients with cerebral sparganosis, admitted to and accepted surgery in our hospital from January 2001 to December 2017. These patients were divided into two groups according to whether the live worms were removed during the operation, namely live worms removal group and live worms non-removal group;factors affecting the removal of live worms were analyzed. Results A total of 36 live worms were removed from 49 patients, one of them took out two live worms in the same lesion. In 45 patients with seizures before surgery, 39 of them had seizure-free after surgery (Engel grading I). Re-examination MR imaging showed that lesions disappeared and no new lesions were found in the brains of the 39 patients. Another two with original lesion enhancement had shadow disappearance;however, new lesions appeared behind the lesion;one of them was re-operated in the contralateral temporal lobe of the original lesion, and the other one continued follow-up observation. No new hemorrhage lesion, infarction or meningitis after operation was noted in all patients. Statistical analysis showed that there were significant differences in times from lesion discovery to surgery and lesion locations between patients of the live worms removal group and the live worms non-removal group (P<0.05). Conclusions Surgical treatment of cerebral sparganosis is safe and effective. Surgical treatment should be performed as soon as possible after the lesion is discovered. The times from lesion discovery to operation should be shortened to prevent the displacement of the worms. At the same time, it is necessary to select the specific surgical plan and timing of surgery in combination with lesion location to improve removal rate of live insects and reduce surgical complications. If necessary, surgery can be performed again.
作者
金鑫
刘朋飞
孙祯卿
谭家亮
吴杰
朱丹
Jin Xin;Liu Pengfei;Sun Zhenqing;Tan Jialiang;Wu Jie;Zhu Dan(Department of Neurosurgery, Guangdong 999 Brain Hospital, Guangzhou 510510, China)
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2019年第5期522-527,共6页
Chinese Journal of Neuromedicine
