李富紅，周 亮，賈金虎

蘭州軍區(qū)蘭州總醫(yī)院 1.肝膽外科； 2.病理科，甘肅 蘭州 730050； 3.酒泉市人民醫(yī)院呼吸內(nèi)科

食管囊蟲病1例報道

李富紅1，周 亮2，賈金虎3

蘭州軍區(qū)蘭州總醫(yī)院 1.肝膽外科； 2.病理科，甘肅 蘭州 730050； 3.酒泉市人民醫(yī)院呼吸內(nèi)科

囊蟲病是指人體感染豬肉絳蟲的囊尾蚴引起的寄生蟲病，多見于進食感染豬肉絳蟲的生豬肉或半熟豬肉的人群，絳蟲多寄生于人體小腸下段，偶有寄生于人體腦部、舌體、心包、眼部及其他肌肉組織中，寄生于人體食管黏膜者少見。主要表現(xiàn)為消化道不適及體質(zhì)量減輕，患病早期多表現(xiàn)為胃酸、腹脹、惡心、腹痛等癥狀，臨床易誤診為消化性潰瘍或胃炎。本文就我院就診的1例食管囊蟲病患者報道如下。

食管；囊蟲??；防治

病例 患者,男，31歲，因“腹脹、惡心、反酸1個月”就診于我院?；颊哂?個月前無明顯誘因出現(xiàn)腹脹、反酸、惡心，以進食后為著，自服奧美拉唑等藥物治療療效欠佳。患者既往無“肝炎”、“結(jié)核”等特殊病史，自幼身體消瘦，既往從事餐飲工作多年。入院后行電子胃鏡檢查提示：距門齒25 cm及30 cm處分別可見黏膜下白色線狀異物，呈蛇形規(guī)律彎曲，考慮寄生蟲病(見圖1)。病理檢查結(jié)果提示囊腫病，蟲體為六鉤蚴(見圖2)。因患者拒絕進一步治療出院。

圖1 食管黏膜下寄生蟲蟲體附著 A：食管下段距門齒25 cm處可見線狀物附著于食管黏膜下；B：食管下段距門齒30 cm處可見線狀物附著于食管黏膜下

Fig 1 Attachment of the parasite to the lower esophageal mucosa A:The lower esophagus distance 25 cm incisors showed thread attaching to esophageal submucosai;B:The lower esophagus distance 30 cm incisors showed thread attaching to esophageal submucosa

圖2 蟲體病理圖像(100×)

討論 囊蟲病是人體食用感染豬肉絳蟲的豬肉引起的人寄生蟲病，又稱有鉤絳蟲[1]，人是其感染的最終宿主，主要通過誤食蟲卵或節(jié)片所致，多寄生于人體平滑肌、心臟、骨骼肌，偶有寄生于舌肌、腦部等部位[2]，對寄生人體的損害也因部位及蟲體數(shù)量不同而差別很大。人主要通過自體內(nèi)感染、自體外感染及異體感染，臨床上囊蟲寄生食管黏膜者少見。機體感染囊蟲病后可出現(xiàn)多種并發(fā)癥，消化道囊蟲病可致消化道梗阻、惡心、嘔吐、黃疸、消瘦、食欲不振及貧血，腦囊蟲病可致癲癇發(fā)作。臨床往往因癥狀不典型而誤診或漏診，目前關(guān)于囊蟲病的診斷最理想的方法是蟲體活檢[3]，主要以手術(shù)取出蟲體及藥物吡喹酮驅(qū)蟲治療[4-5]，但囊蟲病的預防顯得更為重要，注意飲食衛(wèi)生、不吃生食、保證上市豬肉安全才是囊蟲病根本的防治措施。

[1]姚立新, 鄒文遠, 錢萬科, 等. 腦囊蟲病的病理與磁共振成像表現(xiàn)[J]. 新鄉(xiāng)醫(yī)學院學報, 2008, 25(1): 74-75. Yao LX, Zou WY, Qian WK, et al. MRI manifestation and pathology of brain cysticercosis [J]. Journal of Xinxiang Medical College, 2008, 25(1): 74-75. [2]莫鋒, 郭海城. 腦囊蟲病的影像學分析[J]. 臨床研究, 2013, 11(17): 200. Mo F, Guo HC. The imaging analysis of cerebral cysticercosis [J]. Guide of China Medicine, 2013, 11(17): 200.

[3]張春紅. 中西醫(yī)結(jié)合治愈豬肉絳蟲病25例體會[J]. 醫(yī)學理論與實踐, 2011, 24(1): 57-58. Zhang CH. Traditional Chinese and Western Medicine in treatment of 25 cases of tapeworm disease [J]. J Med Thero & Prac, 2011, 24(1): 57-58.

[4]周國興．寄生蟲病藥物手冊[M]. 成都: 科技大學出版社, 1990: 87. Zhou GX. Drug handbook of parasitic disease [M]. Chengdu: University of Science and Technology Press, 1990: 87. [5]李文英, 高澤明, 李長密. 大劑量吡喹酮治療腦囊蟲病717例分析[J]. 中國誤診學雜志, 2010, 10(12): 2909. Li WY, Gao ZM, Li CM. Analysis of high dose praziquantel in treatment of 717 cases of cerebral cysticercosis [J]. Chin J Misdiagn, 2010, 10(12): 2909.

(責任編輯：馬 軍)

Esophageal cysticercosis: one case report

LI Fuhong1, ZHOU Liang2, JIA Jinhu3

1. Department of Hepatobiliary Surgery; 2. Department of Pathology, Lanzhou General Hospital of Lanzhou Military Command, Lanzhou 730050; 3. Department of Respiratory Diseases, the People’s Hospital of Jiuquan City, China

Cysticercosis is a kind of parasitic diseases that infect the pork tapeworm, it often occurs on the people who eat fresh pork or half cooked pork. The tapeworms are parasitic usually under the small intestine segment in humans, or parasitic on the human brain and tongue body occasionally or pericardium and in the eyes and the other person muscle tissue. It is rarely parasitic in esophageal mucosa of human. The mainly symptoms are gastrointestinal discomfort and weight loss. The early characteristics are hydrochloric acid in gastric juice, abdominal distention, nausea, abdominal pain and other symptoms. It is easily misdiagnosed as peptic ulcer or gastritis in clinic. In this paper, one case of esophageal cysticercosis patient was reported.

Esophagus; Cysticercosis; Prevention and treatment

賈金虎，碩士,研究方向：呼吸、消化病的診治。E-mail: jiajinhu1987@163.com

10.3969/j.issn.1006-5709.2016.08.013

個案報道

R571

B

1006-5709(2016)08-0888-01

2015-12-21