成人肺细粒棘球蚴病1例

A Case of Adult Pulmonary Cystic Echinococcosis

摘要: 目的：本次以云南1例成人肺细粒棘球蚴病为讨论目标，通过回顾其诊治经过，进行更深入细致的分析和探讨，力求充分掌握患者疾病问题，为当地防治本病种提供一定临床思路。过程：该患者因咳嗽、咳痰2年余，加重伴胸痛10余天于2021年07月20日入院，入院后完善双肺CT、气管镜、肺泡灌洗液寄生虫核酸检测等明确诊断为肺细粒棘球蚴病，积极开展病原学治疗，于病原学治疗4天后自动出院，出院第2日死亡。分析：考虑患者病史长，既往辗转于当地诊所，未规范诊治，入院时已合并严重肺部感染、肝功能不全等，贻误最佳治疗时机，最终死亡。讨论：棘球蚴病一般经积极病原学治疗后愈后佳，但该患者最终死亡，不排除发生类赫氏反应引起急症、包囊破裂堵塞气管引起窒息导致的死亡，提示临床应早期诊断、治疗，开展病原学治疗时应密切关注患者生命体征、及时干预或暂中断病原学治疗，内外科联合诊治，为改善患者预后、提高生存率提供思路。

Abstract: Objective: The objective of this study was to discuss a case of pulmonary cystic echinococcosis in an adult in Yunnan Province. By reviewing the diagnosis and treatment of the case, more in-depth analysis and discussion were carried out to fully grasp the disease problems of the patient and pro-vide certain clinical ideas for local prevention of the disease. Process: The patient was admitted to hospital on July 20, 2021 due to cough and sputum for more than 2 years, aggravation and chest pain for more than 10 days. After admission, chest CT, tracheoscopy and nucleic acid detection of parasitic parasites in alveolar lavage fluid were performed, and confirmed as pulmonary cystic echinococcosis. Active etiological treatment was carried out, and the patient was discharged auto-matically after 4 days of etiological treatment, and died 2 days after discharge. Analysis: Consider-ing that the patient had a long medical history and had been transferred to the local clinic without standard diagnosis and treatment, the patient had been complicated with severe pulmonary infec-tion and liver insufficiency upon admission, delaying the best treatment opportunity and eventually dying. Discussion: Echinococcosis generally recovered well after active etiological treatment, but the patient eventually died, not limited to the death caused by emergency and asphyxia caused by Herxheimer-like reaction, cyst rupture and blockage of the trachea, suggesting that early clinical diagnosis and treatment should be performed. During etiological treatment, close attention should be paid to the patient’s vital signs, timely intervention or temporary interruption of etiological treatment, and combined diagnosis and treatment between medicine and surgery. It provides ideas for improving the prognosis and survival rate of patients.