Kev Sib Tw Hauv Kev Kho Mob Raum Echinococcosis Nrog Gross Hydatiduria Thiab Lub raum Tsis Zoo: Ib Daim Ntawv Qhia Txog
Mar 06, 2022
Taw qhia
Tib neeg echinococcosis, feem ntau hu ua kab mob hydatid, tsis tau tshaj tawm, tseem yog ib qho mob hnyav heev, zoonotic kab mob uas tau raug cais los ntawm World Health Organization (WHO) ua ib qho ntawm cov kab mob loj uas tsis saib xyuas raws li tau tshaj tawm hauv lawv thawj daim ntawv tshaj tawm ntawm cov koom haum no [1 ]. Txawm hais tias nws tuaj yeem ua asymptomatic rau ntau xyoo, qhov xwm txheej ntawm echinococcosis thiab nws lub peev xwm nthuav dav mus rau ntau lub hauv nruab nrog cev tuaj yeem ua rau muaj kev cuam tshuam tsis zoo thiab teeb meem kev kho mob [1]. Whereas echinococcosis yog ib qho chaw nyob rau qee thaj tsam, xws li Middle East, sub-Saharan Africa, thiab Central thiab South America, cov neeg mob tau tshaj tawm thoob ntiaj teb, [2] thiab cov ntaub ntawv qhia tias echinococcosis tau rov tshwm sim los ua qhov teeb meem kev noj qab haus huv tseem ceeb rau pej xeem, yuam kom muaj nce qib ntawm kev mloog [3]. Echinococcosis muaj qhov cuam tshuam rau feem ntau ntawm daim siab ua raws li lub ntsws, tab sislub raumKev koom tes tuaj yeem tshwm sim, txawm tias tsawg heev, ua rau muaj kev cuam tshuam ntawm cov tsos mob [4, 5].Lub raum echinococcosis feem ntau yog kho phais [5], tab sis cov kev coj ua tam sim no tsis muaj kev pom zoo rau lwm cov kev kho mob rau cov neeg mob uas xaiv tawm ntawm kev phais, thiab cov ntaub ntawv ntawm lawv cov kev ua tau zoo yog qhov sib cav thiab tsis tshua muaj. Hauv tsab ntawv ceeb toom no, peb tab tom nthuav tawm cov xwm txheej tshwj xeeb ntawmlub raumechinococcosis nthuav tawm nrog tag nrho hydatiduria thiab kev puas tsuaj loj ntawm parenchymal kho nrog kev kho dual antiparasitic tshwj xeeb tom qab tsis kam phais. Peb nthuav tawm rooj plaub no rau nws qhov tsis tshua muaj thiab cov teeb meem cuam tshuam nrog nws txoj kev kho atypical. Peb cia siab los ntawm tsab ntawv ceeb toom no los ua kom muaj qhov sib txawv tseem ceeb hauv kev tswj xyuas kev kho moblub raumechinococcosis thiab qhia kev tsim cov lus pom zoo txog nws cov tshuaj kho mob, tshwj xeeb tshaj yog thaum cov kev xaiv phais tsis ua tau.
Ntsiab lus:Albendazole, Case report, Hydatid cyst, Hydatiduria, Lub raum echinococcosis, raum, raum
CISTANCHE yuav txhim kho lub raum / raum mob
Case nthuav qhia
Ib tus txiv neej Syrian muaj hnub nyoog ib xyoos tau nthuav tawm rau lub chaw kho mob kis kab mob sab nraud ntawm peb lub tsev kho mob nrog kev tsis txaus siab tseem ceeb ntawm qhov mob ntawm sab xis sab xis uas cuam tshuam nrog cov zis tsaus nti nrog rau kev hla ntawm ntau lub pob zeb thiab cov xim txiv kab ntxwv-dawb daim tawv nqaij -zoo li cov qauv hauv cov zis (Fig. 1). Tsis muaj hematuria lossis lwm yam tsos mob ntawm cov zis hauv qis. Qhov tseem ceeb, tus neeg mob tau tshaj tawm txog keeb kwm yav dhau los ntawm kab mob siab hydatid cyst ob peb xyoos dhau los uas tau tswj hwm nrog percutaneous aspiration-injection-respiration (PAIR) cov kua dej thiab albendazole uas nws nrhiav kev txiav tawm tom qab ob peb lub hlis ntawm kev siv. Nws lees paub tias tsis nrhiav kev kho mob rov qab vim muaj kev txwv nyiaj txiag tom qab kev daws teeb meem thiab tsis muaj kev rov tshwm sim ntxiv. Tus neeg mob yog tus tswv yug yaj los ntawm txoj haujlwm, siv nws lub neej laus feem ntau hauv Syria ua ntej khiav tawm hauv kev tsov rog hauv 2015 thiab nkag mus rau Kuwait. Nws muaj keeb kwm ntev ntawm kev haus luam yeeb, tab sis cov keeb kwm yav dhau los yog qhov tsis zoo.
Thaum lub sij hawm nws thawj zaug mus ntsib, tus neeg mob tsis tshwm sim nyob rau hauv mob hnyav los yog mob. Nws yog afebrile thiab hemodynamically ruaj khov nrog cov ntshav siab ntawm 134/78 mmHg thiab lub plawv dhia ntawm 76 neeg ntaus ib feeb. Kev kuaj mob plab yog qhov zoo tshaj plaws rau txoj cai flank rhiab rau percussion yam tsis muaj pov thawj ntawm hepatosplenomegaly. Tsis muaj qhov mob plab lossis cov tsos mob ntawm peritoneal irritation. Qhov seem ntawm qhov kev kuaj ntawd yog qhov qub. Tus neeg mob tau txais mus rau kev ua haujlwm thiab kev tswj xyuas ntxiv.
Initial laboratory workup showed no evidence of leukocytosis or eosinophilia. His serum creatinine was 1.03 g/dL (normal value: 0.9–1.3 g/dL) and hemoglobin was 13.6 g/dL (normal value: 14–16 g/dL). Electrolytes were normal and so were liver function tests. Urinalysis showed an excess of leukocytes and microscopic hematuria (6–7 red blood cells/high-power field), with no bacterial growth on culture. Calculated glomerular filtration rate (GFR) was 81 mL/minute/1.73 cm 2 (normal value >90). Cov pob zeb tso tawm tau raug sau thiab xa mus rau kev tshuaj xyuas, uas tom qab ntawd pom muaj kev sib xyaw ntawm calcium oxalate thiab urate. Hydatid serology siv Echinococcus indirect hemagglutination assay (IHA) (ELI.HA, cov khoom siv naj npawb 66604) tau khiav ib zaug thiab rov qab zoo ntawm titer ntawm 1: 2048. Kev yees duab tau txais tom ntej.Lub raum, ureter thiab zais zis (KUB) x-ray zoo li qub thaum alub raumultrasound qhia ntau yam unilocular hypoechoic cystic
cov qauv hauv txoj cairaumnrog sib xyaw homogeneous thiab heterogeneous Cheebtsam. Contrast-enhanced computed tomography (CT) KUB tau nthuav tawm peb qhov loj me me tuab-walled exophytic cystic lesions nyob nruab nrab thiab qis ntawm sab xisraumnrog heterogeneous, nonnenhancing, thiab hyperdense Cheebtsam (Bosniak qeb III), nrog rau qhov loj tshaj plaws ntsuas 9 × 8 × 7.5 cm thiab compressing lub pancreatic lub taub hau, txoj cai nyuv, thiab thib ob ib feem ntawm lub duodenum (Fig. 2). Qee lub sij hawm ciam teb calcification thiab kev sib txuas lus ntawm cyst thiab pelvicalyceal system (daj xub) kuj pom. Ntawm kev txhawj xeeb, cov kab mob cystic tau nkag mus rau txoj cailub raumhilum, ua raulub raumpelvic compression thiab qib III hydronephrosis. Cov calyces tau ntim nrog cov khib nyiab thiab lub pob zeb me me uas ntsuas 11 × 4 mm. Los ntawm qhov sib txawv, sab laugraumNws yog tag nrho thiab pathologically tsis koom nrog. Raws li nws txoj kev koom tes hauv hepatic yav dhau los, ib ntu tsis zoo ntawm
txoj cai hepatic lobe nrog ciam teb calcification kuj tau pom thiab qhia txog kev cuam tshuam ua ntej los kho tus kab mob siab. Raws li kev tshawb pom ntawm CT scan, kev xa mus rau qhov kev pabcuam urology tau pib, thiab tus neeg mob tom qab ntawd tau ua haujlwm zoo.lub raumscintigraphy los ntsuas qhov ua haujlwm ntawm txoj cairaum. Scintigraphy tau qhia txog qhov txo qis ntawm cov neeg taug qab thiab cov kev tso tawm tsis zoo qhia txog kev ua haujlwm tsis zoo (5 feem pua) ntawm txoj cairaumvim qhov kev puas tsuaj loj ntawm parenchymal thiab hloov pauv los ntawm cov hlwv uas tsis yog qhov ua haujlwm zoo sab laugraum.Cov kev tshawb pom CT thiab scintigraphy qhia tau hais tias tsis muaj kev tiv thaiv ntawm txoj cairaumtab sis tsis muaj pov thawj ntawm overtraum tsis ua haujlwmraws li kev txhawb nqa los ntawm cov ntshav creatinine ib txwm muaj thiab tsuas yog txo qis GFR vim tsis muaj kev cuam tshuam ntawm sab laugraum.
Raws li tus neeg mob cov lus qhia txog kev ua haujlwm yav dhau los, keeb kwm yav dhau los ntawm tus kab mob hydatid, zoo serology, pathognomonic nthuav qhia ntawm hydatiduria, thiab CT KUB tshawb pom, kev kuaj mob ua ntej ntawmlub raumechinococcosis nrog qhov tseem ceeb unilaterallub raumkev puas tsuaj tau ua. Kev kuaj mob ntawm necroticlub raumcell carcinoma tau luv luv txiav txim siab muab qhov xwm txheej ntawm qhov txhab, qhov muaj calcification, thiab tus neeg mob keeb kwm kev haus luam yeeb, tab sis lub hnub qub ntawm qhov kev tshawb pom saum toj no ua rau kev kuaj mob tsis zoo. Ntawm qhov kev ceeb toom, ciam teb calcification tuaj yeem kuaj pom hauv hydatid cyst thiab, thaum ua tiav, yog qhov qhia txog kev tsis sib haum xeeb lossis kev tuag ntawm cov cab [6]. Inherited cystic kab mob ntawm tus kab mobraum,xws li polycysticmob raum, tuberous sclerosis, thiab Von Hippel-Lindau syndrome, tsis zoo li vim muaj kev koom tes ib leeg, tsis muaj lwm yam kabmob, thiab tsis muaj tsev neeg keeb kwm zoo. Muaj peev xwm ntaulub raumabscesses tau tsa, tab sis tus neeg mob cov tsos mob tsis pom zoo, qhov tsis zoo ntawm cov zis urinalysis, thiab cov kab mob tso zis ib txwm txav nws qis dua ntawm daim ntawv.
Tom qab sau cov ntaub ntawv los ntawm tus neeg mob keeb kwm thiab kev tshawb nrhiav thiab kev sab laj nrog kev pabcuam urology, tus neeg mob tau qhia meej txog nws qhov kev kuaj mob, kev kuaj mob, thiab muaj kev kho mob phais. Vimraumnonsalvageability, unilateral nephrectomy tau pom zoo kom tso cai rau kev tshem tawm tag nrho ntawm tus kab mob thiab tiv thaiv kev rov tshwm sim; nws tau qhia meej txog qhov txaus ntshai, cov txiaj ntsig, thiab lwm txoj hauv kev rau kev phais mob, suav nrog PAIR thiab kev kho mob tshwj xeeb. Tus neeg mob tau xaiv xaiv tawm ntawm kev phais thiab txiav txim siab rau kev kho mob tshwj xeeb. Yog vim li cas rau kev tsis kam phais yog qhia nyob rau hauv tus neeg mob txoj kev xav hauv qab no. Tus neeg mob tau pib ntawm kev kho dual antiparasitic nrog albendazole (400 mg × 2 hnub) thiab praziquantel (40 mg / kg ib lub lim tiam). Nws kuj tau qhia kom noj cov kua dej ntau ntxiv thiab noj acetaminophen raws li qhov xav tau ntawm qhov mob.
Tus neeg mob tau txiav txim siab txuas ntxiv mus nrhiav kev saib xyuas kev kho mob hauv nws lub tebchaws thiab tej zaum yuav xav txog kev ua PAIR hauv Syria. Los ntawm peb qhov kev xav, txoj kev npaj yog mus txuas ntxiv kev kho mob nrog albendazole thiab praziquantel rau 3-6 lub hlis ntev rau tam sim no thiab rov ua cov serology titers thiab cov duab los soj ntsuam cov kab mob thiab cov lus teb rau kev kho mob. Tom qab pib kho, tus neeg mob txuas ntxiv mus tom peb lub tsev kho mob rau 4 lub hlis thiab qhia txog kev daws teeb meem ntawm cov tsos mob, suav nrog hydatiduria. Kev soj ntsuam tom qab, suav nrog cov ntshav creatinine, tseem nyob ib puag ncig thaum rov ua dua Echinococcus serology pom qhov poob qis hauv titers los ntawm 50 feem pua rau 1: 1024, uas ua ke qhia txog kev kho mob thiab kev txhim kho serologic thiab txaus siab rau kev kho mob txog qhov no. Tus neeg mob tau lees paub tias nws tau ua raws li cov tshuaj thiab qhia tias tsis muaj kev cuam tshuam dab tsi thiab yog li ntawd tau hais kom nws mus txuas ntxiv nws cov tshuaj kho mob. Tus neeg mob tsis kam lees txais cov duab ntxiv los ntsuam xyuas kev txhim kho hluav taws xob nyob rau lub sijhawm no tab sis tau qhia nws lub siab xav kom pab pawg qhia txog nws cov kev hloov kho tshiab hauv nws lub tebchaws.
CISTANCHE yuav txhim kho lub raum / raum tsis ua haujlwm
Kev sib tham thiab xaus
Tib neeg echinococcosis yog kab mob parasitic tshwm sim los ntawm cov kab mob ntawm Echinococcus cestode. Thaum cov genus no muaj ntau hom, cov tseem ceeb ntawm lawv yog E. granulosus thiab E. multilocularis, ua rau cystic thiab alveolar echinococcosis, feem. E. granulosus muaj lub voj voog ntawm lub neej nyuaj uas cuam tshuam nrog tus tswv tsev, feem ntau yog dev, thiab tus tswv tsev nruab nrab, uas tuaj yeem ua rau tib neeg. Cov tib neeg hauv qee thaj chaw muaj kev pheej hmoo, tshwj xeeb yog cov neeg yug yaj uas tuaj ze nrog cov dev. Thaum fecal-qhov ncauj kis ntawm ova, larvae hatching nyob rau hauv txoj hnyuv me nkag mus rau hauv txoj kev thiab feem ntau tsiv mus rau lub siab thiab ntsws qhov chaw uas lawv nyob twj ywm nyob rau hauv cov ntaub ntawv encysted (thawj echinococcosis). Yog hais tias ib tug hydatid cyst ruptures, liberated protoscolices yuav kis tau mus rau ntau yam kab mob nyob rau hauv uas lawv tsim ib tug thib ob kab mob los yog tshwm sim heev nrog rupture cov tsos mob uas muaj xws li kub taub hau thiab urticaria mus rau ib tug tag nrho-fledged anaphylactic shock [4].
Lub raum involvement ntawm E. granulosus kab mob yog qhov tsawg heev nrog qhov tshwm sim tsawg li 2-3 feem pua ntawm cov neeg mob uas muaj cystic echinococcosis [5]. Yog tias tau sau tseg, nws feem ntau tshwm sim nyob rau hauv qhov chaw ntawm cov kab mob sib kis los ntawm hematogenous los yog retroperitoneal lymphatic kis nrog rau cov kabmob feem ntau, tab sis cais tawm.lub raumcystic echinococcosis, txawm tias tsis tshua muaj (1.9 feem pua), tau tshaj tawm hauv cov ntaub ntawv [7]. Lub raum hydatid cyst feem ntau nyob ib leeg nyob rau sab sauv lossis qis ntawm tus ncejraumthiab cortical hauv qhov chaw. Txawm hais tias feem ntau asymptomatic, cov neeg mob tshwj xeeb lojlub raumcysts (>10 cm) tuaj yeem pom cov cim qhia thiab cov tsos mob uas txawv ntawm qhov tsis xis nyob, palpable loj, thiab hematuria mus rau mob.lub raumcolic, kub siab, thiab txawmraum tsis ua haujlwm[8–10]. Hydatiduria, los yog txoj kev ntawm tus ntxhais cysts nyob rau hauv cov zis, yog ib qho tsis tshua muaj (10-20 feem pua ntawm cov neeg mob) tsis tau pathognomonic feature uas ua raws li cyst rupture mus rau hauv lub pelvicalyceal system (Fig. 3) thiab tau ua qhov kev tsis txaus siab ntawm peb tus neeg mob [5] . Txawm hais tias feem ntau microscopic, peb tus neeg mob muaj tag nrho hydatiduria, ua rau muaj qhov tsis txaus ntseeg ntawm kev kuaj mob.lub raumkev koom tes thiab qiv nyiaj txhawb nqa rau cov duab tshawb pom [9]. Lub raum hydatid cyst tuaj yeem raug kaw lossis nthuav tawm raws li txheej txheej txheej, thiab tsis sib txuas lus lossis qhib raws li txheej kev ncaj ncees raws li qhia hauv daim duab 3 [11].
Kev sim kuaj pom eosinophilia (hauv tsuas yog 50 feem pua ntawm cov neeg mob) thiab cov serology zoo yuav pab tau kom txo qis cov npe ntawm qhov sib txawv, tshwj xeeb tshaj yog nrog cov keeb kwm raug cuam tshuam, tab sis cov duab kos duab yog qhov tseem ceeb rau kev tsim ib qho kev kuaj mob ib nrab.mob raum, tshwj xeeb tshaj yog thaum serology tsis zoo [5]. Alub raumultrasound yuav qhia tau tias muaj cortical cysts, tus ntxhais cysts, floating membranes, thiab hydatid xuab zeb (Gharbi faib), tab sis ib tug CT scan, nrog ib tug rhiab heev li 98 feem pua, yog ntau yielding thiab pab ntsuam xyuas rau anatomic kev ncaj ncees thiab extrarenal kab mob. [12]. Interestingly, peb tus neeg mob muaj cov pob zeb tso zis ib txhij, zoo ib yam li cov ntaub ntawv dhau los nrog cov kev tshawb pom zoo sib xws [9] thiab ob daim ntawv tshaj tawm txog qhov xwm txheej.lub raumhydatid kab mob hauv cov neeg mob kho nephrolithiasis [13, 14]. Txawm hais tias qhov no tuaj yeem yog vim muaj caij nyoog ib leeg, nws yuav xav paub txog seb puas yoglub raumTus kab mob hydatid txhawb nqa pob zeb tsim nyob rau hauv cov zis thiab sim ua kom paub meej lub hauv paus ntawm kev sib koom ua ke, yog tias muaj, uas yuav los yog tsis zoo ib yam li lwm yam kab mob uas txhawb nqa pob zeb. Lwm qhov ua tau yog tias cov kab mob nkag tuaj yeem ua rau obstructive uropathy thiab tso zis stasis uas nyiam tsim nidus thiab nag lossis daus.
Txawm hais tias kev phais yog lub hauv paus ntawmlub raumechinococcosis kev kho mob, ntau yam tuaj yeem ua si thaum xaiv cov kev xaiv phais lossis, theej, txaus nrog kev kho mob, suav nrog cyst qhov chaw thiab qhov loj, qib ntawm kev puas tsuaj parenchymal, thiab, ntawm chav kawm, tus neeg mob nyiam [5]. Kev xaiv phais muaj xws li nephrectomy yooj yim thiab ib nrab nephrectomy, uas tuaj yeem ua laparoscopically nrog cov txiaj ntsig zoo tom qab [15, 16]. Txawm li cas los xij,raum-sparing phais, xws li cystectomy los yog pericystectomy, yuav tsum tau nrhiav thaum twg los tau tshaj radical phais kom khaws cia.lub raum ua haujlwm[17]. Yog hais tias lub cyst txuas mus rau
pelvicalyceal system, endocystectomy nrog qhov tsis xws luag yuav ua tau [5]. Perioperative albendazole kuj tseem yuav tsum tau pib ua kev kho mob ntxiv kom txo qis kev rov tshwm sim thiab tiv thaiv anaphylaxis, qhov kev pheej hmoo ntawm uas tuaj yeem txo qis los ntawm kev tswj cov tshuaj tua kab mob scolicidal [17]. Ib lub hlis ntawm preoperative albendazole diminishes larval kev ua si thiab yog txuas mus rau peb lub hlis ntxiv tom qab phais kom txo tau rov tshwm sim [18]. Yog hais tias kev phais yog ua laparoscopically, ib txoj hauv kev retroperitoneal tuaj yeem txo qis peritoneal noob yog tias lub cyst ruptures yuam kev, tab sis raws li malignancy tsis tuaj yeem raug cais nrog qhov tseeb ua ntej, txoj hauv kev transperitoneal yuav yog ib qho kev xaiv [17]. PIB alub raumhydatid cyst yog ib qho kev ua haujlwm tsawg dua uas tau tshaj tawm hauv cov ntaub ntawv nrog kev sib cav txog qhov ua tau zoo thiab muaj kev pheej hmoo siab ntawm peritoneal noob thiab anaphylaxis uas yuav txwv tsis pub siv rau cov neeg mob phais tsis zoo [19].
Txawm hais tias kev puas tsuaj loj ntawm parenchymal thiab cyst txuas ntxiv, raws li pom los ntawm hydatiduria, xav tau kev phais mob, peb tus neeg mob tsis tau xaiv rau kev phais thiab nrhiav kom tau txais cov tshuaj tiv thaiv kab mob ib leeg. Kev kho mob tshwj xeeb raulub raumKab mob hydatid yog suav hais tias yog ib qho kev coj ua tsis tshua muaj. Qhov tseeb, cov lus qhia ruaj khov uas piav qhia meej thiab cov txheej txheem ntawm kev kho tshuaj raulub raumechinococcosis tsis muaj tam sim no. Cov ntaub ntawv xov xwm piav qhia txog kev kho mob tshwj xeeb raulub raumTus kab mob hydatid yog qhov sib txawv me me piv nrog nws cov kab mob siab lossis cov kab mob pulmonary, tsis muaj kev pom zoo tam sim no ntawm cov xwm txheej uas siv cov tshuaj kho mob ib leeg yuav txaus. Tsis tas li ntawd, yog tias siv tshwj xeeb, koob tshuaj thiab lub sijhawm ntawm kev kho mob albendazole yuav tsum tau ua kom haum rau tus neeg mob kho mob nrog.lub raumechinococcosis kom ntseeg tau tias muaj kev tshem tawm ntau dua uas yuav ua kom yooj yim dua nrog kev phais.
Hauv kev tshawb nrhiav yav dhau los tau ua los tshawb xyuas qhov tshwm sim ntawm qhov chaw txawv ntawm tus kab mob hydatid, nws tau tshaj tawm tias tus poj niam tus neeg mob uas muaj cov tsos mob me me.lub raumhydatid cyst tau txais kev kho mob pharmacological ib leeg thiab txhim kho [20]. Txawm hais tias tau cog lus tseg, qhov laj thawj ntawm kev soj ntsuam tom qab siv rau kev kho mob tshwj xeeb tsis tau qhia meej, thiab tsis tau muaj qhov ntsuas ntsuas kev txhim kho hauv tus neeg mob no. Daim ntawv ceeb toom tau piav qhia txog tus neeg mob muaj hnub nyoog 14- xyoo nroglub raumTus kab mob hydatid uas tau kho tshwj xeeb nrog plaub 4- lub lim tiam ntawm albendazole, uas ua rau muaj kev ua haujlwm tsis zoo thiab ua rau txo qis hauv lub cyst loj (los ntawm 9 × 9 × 6.8 cm rau 3.6 × 3.4 × 2.3 cm) [21]. Ntawm qhov tod tes, lwm daim ntawv tshaj tawm yog ntawm tus neeg mob muaj hnub nyoog 79- xyoo nrog alub raumhydatid cyst uas tsis kam phais thiab tau pib nyob rau txhua hnub praziquantel thiab albendazole rau 26 lub hlis ua ntej dhau los ua neeg tsis zoo thiab yog li ntawd tau thov kom tso tseg cov tshuaj. Ib cag ntawm ib qho kev rov ua dua tshiab, tus neeg mob tau pom tias muaj kev txhim kho tseem ceeb hauv cyst loj thiab cov tsos mob siv tshwj xeeb dual pharmacotherapy [12]. Whereas albendazole halts cyst kev loj hlob, praziquantel tua kab mob plab hnyuv thiab larval protoscolices, tiv thaiv kev tsim cov cysts thib ob [22, 23]. Ib qho kev ntsuam xyuas meta-kev ntsuam xyuas cov kev kho mob sib txawv ntawm cystic echinococcosis tiag tiag tau pom ntau dua scolicidal thiab anticystic kev ua haujlwm, thiab yog li kev txhim kho thiab kho tus nqi, thaum ob qho tshuaj siv ua ke piv nrog albendazole ib leeg. Tsis tas li ntawd, ob txoj kev kho mob yuav txo tau qhov kev pheej hmoo ntawm kev rov tshwm sim dua thiab intraperitoneal noob yog rupture lossis spillage tshwm sim [23]. Hauv lwm txoj kev tshawb nrhiav tsis yog kev sim, cov neeg mob uas muaj ntau yam hydatid cysts tau kho nrog peb 4- lub lim tiam ntawm albendazole thiab praziquantel thiab tau ua raws li qhov nruab nrab ntawm 18 lub hlis tom qab kho. Clinically, cov tsos mob tau daws nyob rau hauv 77.8 feem pua ntawm cov neeg mob thiab ib feem yog li ntawm 22.2 feem pua. Radiologically, kev txhim kho tseem ceeb tau sau tseg hauv 55.6 feem pua thaum kev txhim kho ib nrab pom hauv 44.4 feem pua [24]. Txawm li cas los xij, cov qauv kev tshawb fawb tsis yog tus sawv cev txaus ntawm cov neeg mobmob raum.
CISTANCHE yuav txhim kho rau lub raum/ raum mob
Txawm hais tias tag nrho cov txiaj ntsig tau txais txiaj ntsig zoo, cov lus teb tsis paub tseeb thiab qhov tsis zoo ntawm kev kho mob tuaj yeem ua rau nws siv raulub raumhydatid tus kab mob tsis tshua nyiam tshaj qhov kev phais tab sis tseem yuav raug txiav txim siab hauv cov neeg mob hluas kom tsis txhob muaj covlub raum, hauv cov kab mob sib kis, thiab hauv cov neeg uas xaiv tawm los yog tsis haum rau kev phais mob [21]. Raws li qhov kev pheej hmoo ntawm kev rov tshwm sim yog siab dua nrog kev siv tshuaj kho mob tshwj xeeb piv nrog kev phais, kev kho mob tuaj yeem txuas ntxiv mus ntxiv uas raug kho raws li kab mob kev loj hlob thiab teb rau kev kho mob [25]. Ntxiv kev soj ntsuam randomized yog li ntawd tau lees paub los tshuaj xyuas qhov ua tau zoo thiab kev qhia txog kev sib xyaw ua ke tshwj xeeb raulub raumechinococcosis, kev siv tshuaj kom tsim nyog, thiab sijhawm txaus ntawm kev kho mob (piv txwv li, 3-6 lub hlis piv rau 12-24 lub hlis piv rau lub neej). yuav ua rau cov kev txiav txim kho mob yav tom ntej uas peb tam sim no yuav pom muaj teeb meem. Txawm hais tias qhov kev txwv ntawm tsab ntawv ceeb toom no yuav yog lub sijhawm luv luv, kev kho mob tshwj xeeb muaj, txawm li cas los xij, tau ua pov thawj zoo thaum peb tus neeg mob tau soj ntsuam kev kho mob thiab serologically.
Ntau qhov kev tiv thaiv tseem tuaj yeem raug coj los tiv thaiv kev kis tus kab mob thiab kis tau tus kab mob echinococcal, tshwj xeeb tshaj yog nyob rau hauv cov neeg muaj kev pheej hmoo siab. Lub chaw tswj hwm kab mob thiab kev tiv thaiv tau tso tawm ob peb cov lus pom zoo hauv qhov no suav nrog kev tiv thaiv cov dev los ntawm kev noj cov tsiaj ntawm cov yaj uas muaj kab mob, tswj cov dev stray, thiab txwv tsis pub tua yaj hauv tsev thiab lwm yam tsiaj txhu [26]. Tsis tas li ntawd, tsis txhob noj zaub mov lossis dej uas yuav kis tau los ntawm tus dev fecal teeb meem, ntxuav tes tom qab tuav cov dev, thiab qhia me nyuam txog qhov tseem ceeb ntawm kev tu cev ntawm tes yuav muaj txiaj ntsig zoo hauv kev tiv thaiv kab mob mus ntev [26]. Ib qho kev tiv thaiv ntxiv yog kho cov dev nrog anthelmintics, uas yog praziquantel, uas pab txhawm rau rhuav tshem cov kab mob hauv lub neej thiab txo cov neeg raug mob [27]. Txawm hais tias kev txhaj tshuaj tiv thaiv ntawm cov dev, cov tswv tsev tseem ceeb, tau raug soj ntsuam raws li kev tiv thaiv kev ntsuas los ntawm ntau qhov kev tshawb fawb, tsis muaj pov thawj me ntsis ntawm qhov ua tau zoo ntawm txoj kev no, nrog rau feem ntau cov ntawv tshaj tawm tau txais txiaj ntsig tsis sib xws [27]. Txawm li cas los xij, nws zoo li tias kev txhaj tshuaj tiv thaiv kab mob nruab nrab xws li yaj yuav yog ib lub tswv yim zoo thiab muaj txiaj ntsig. Qhov tseeb, nws tau pom zoo tias kev txhaj tshuaj tiv thaiv nrog EG95, ib qho oncosphere antigen, nrog 6-kev kho txhua hli ntawm cov dev nrog praziquantel tuaj yeem ua tiav raws sijhawm thiab muaj zog tswj kev sib kis ntawm cystic echinococcosis [27].
Cov ntaub ntawv no yog ib qho piv txwv tseem ceeb ntawm cov teeb meem uas cov kws kho mob ntsib hauv kev xyaum thaum muaj kev sib pauv ntawm cov qauv kev kho mob thiab tus neeg mob txoj kev ywj pheej xav tau kom ua tiav. Nyob rau hauv peb cov ntaub ntawv, tus neeg mob tsis kam nephrectomy, uas nws pom tau tias yuav hnyav dua li cov txiaj ntsig thiab yog li ntawd tau txais kev kho mob. Txawm hais tias cov neeg mob qhov kev txiav txim siab tswj hwm tus kheej tsis tas yuav yog qhov zoo tshaj plaws, lawv tseem yuav tsum tau ntuas kom zoo thiab muaj lwm yam kev xaiv tsim nyog tom qab ntsuas cov pov thawj tshawb fawb. Thaum cov ntaub ntawv ntawm kev kho mob tshwj xeeb raulub raumechinococcosis feem ntau tsis muaj, peb daim ntawv tshaj tawm qhia tau hais tias tau txais txiaj ntsig ntxov ntawm kev siv tshuaj tua kab mob dual antiparasitic nrog albendazole thiab praziquantel, muaj peev xwm taw qhia cov kev sim siab yav tom ntej txhawm rau nthuav tawm cov lus pom zoo rau cov neeg mob kho nrog txoj hauv kev no.
Tus neeg mob txoj kev xav
"Kuv tsis xav tsis thoob vim muaj qhov kev kuaj mob no, Kuv tau nyob nrog nws tau ntau xyoo thiab tuaj txais kev nyob nrog cov hlwv no. Vajtswv yuav saib xyuas kuv; Kuv tso siab rau Vajtswv nrog qhov no thiab vam khom koj, kuv cov kws kho mob. Qhov tseeb, kuv zoo li kuv tab tom txhim kho, cov hlwv uas kuv tau tso zis tau qis dua thiab kuv tsis dhau pob zeb lawm. Kuv tsis mob ntxiv lawm, txhua yam mus zoo. Txawm li cas los xij, kuv tsis lees txais lossis ntseeg cov txiaj ntsig ntawm renogram. . Tsis muaj txoj kev uas kuv txoj cairaumyog ua haujlwm ntawm 5 feem pua. Thaum nws muaj kev nyab xeeb mus ncig, Kuv npaj siab rov qab mus tsev, mus rau Syria. Kuv yuav mus ntsib kuv tus kws kho mob urologist kom nws ua khub ntawm kuvraumcyst. Kuv ntseeg hais tias PAIR kho kuv daim siab cyst xyoo dhau los, thiab nws yuav kho kuv dua. Lub sijhawm no, kuv npaj siab yuav txuas ntxiv albendazole thiab praziquantel uas koj tau sau rau kuv. Kuv xav tias lawv ua haujlwm zoo kawg nkaus los daws kuv cov tsos mob. Qhov kev paub tag nrho no tau muaj kev ntxhov siab, tab sis kuv muaj kev ntseeg rau Vajtswv thiab tias txhua yam tau tshwm sim thiab yog vim li cas. Vajtswv yuav tiv thaiv kuv.
Cov nyiaj txiag, txawm li cas los xij, yog qhov nyuaj tshaj plaws. Cov tshuaj yog kim heev, thiab kuv tsis muaj peev xwm them taus lawv. Ua tsaug rau koj pab kuv tawm; Kuv tsis paub tias kuv yuav ua li cas yog tsis muaj koj. Hais txog kev phais, tsis muaj txoj hauv kev uas kuv yuav pom zoo rau kev kho mob nephrectomy. Kuv ntseeg tias kuv tus mob yuav raug kho nrog albendazole thiab praziquantel, thiab tej zaum PAIR yog kuv nrhiav tom qab. Nephrectomy yuav ua rau kuv hnyav heev thiab kuv yuav tsis txais nws. Kuv tus npawg tau txais kev kho mob nephrectomy thiab tam sim no nws nyob ntawm kev lim ntshav. Tsis muaj txoj hauv kev uas kuv yuav xaus zoo li nws!” Thaum tus neeg mob raug nug kom kos npe rau daim ntawv tso cai, nws hais ntxiv tias: "Kuv zoo siab heev uas lwm tus yuav kawm los ntawm kuv tus mob. Qhov no yuav tsim kev cia siab thiab pab txhawb kev kho mob yooj yim dua rau lwm tus neeg mob uas muaj kev kuaj mob zoo sib xws. Txawm li cas los xij, kuv muaj ib qho kev thov; tsis txhob muab cov duab ntawm kuv renogram hauv koj tsab xov xwm, thov. Kuv tsis xav kom lwm tus raug kev txom nyem los ntawm tib tus kab mob kom freak tawm; Kuv xav kom kuv tus mob muab kev cia siab rau lawv, thiab kuv tsis xav kom lawv xav tias nephrectomy yog tib txoj kev xaiv." Ua raws li tus neeg mob qhov kev thov, cov duab ntawm nws.lub raumscintigraphy tsis suav nrog hauv tsab ntawv ceeb toom no.
