食管囊虫病1例报道

李富红，周 亮，贾金虎

兰州军区兰州总医院 1.肝胆外科； 2.病理科，甘肃 兰州 730050； 3.酒泉市人民医院呼吸内科

食管囊虫病1例报道

李富红1，周 亮2，贾金虎3

兰州军区兰州总医院 1.肝胆外科； 2.病理科，甘肃 兰州 730050； 3.酒泉市人民医院呼吸内科

囊虫病是指人体感染猪肉绦虫的囊尾蚴引起的寄生虫病，多见于进食感染猪肉绦虫的生猪肉或半熟猪肉的人群，绦虫多寄生于人体小肠下段，偶有寄生于人体脑部、舌体、心包、眼部及其他肌肉组织中，寄生于人体食管黏膜者少见。主要表现为消化道不适及体质量减轻，患病早期多表现为胃酸、腹胀、恶心、腹痛等症状，临床易误诊为消化性溃疡或胃炎。本文就我院就诊的1例食管囊虫病患者报道如下。

食管；囊虫病；防治

病例 患者,男，31岁，因“腹胀、恶心、反酸1个月”就诊于我院。患者于1个月前无明显诱因出现腹胀、反酸、恶心，以进食后为著，自服奥美拉唑等药物治疗疗效欠佳。患者既往无“肝炎”、“结核”等特殊病史，自幼身体消瘦，既往从事餐饮工作多年。入院后行电子胃镜检查提示：距门齿25 cm及30 cm处分别可见黏膜下白色线状异物，呈蛇形规律弯曲，考虑寄生虫病(见图1)。病理检查结果提示囊肿病，虫体为六钩蚴(见图2)。因患者拒绝进一步治疗出院。

图1 食管黏膜下寄生虫虫体附着 A：食管下段距门齿25 cm处可见线状物附着于食管黏膜下；B：食管下段距门齿30 cm处可见线状物附着于食管黏膜下

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

图2 虫体病理图像(100×)

讨论 囊虫病是人体食用感染猪肉绦虫的猪肉引起的人寄生虫病，又称有钩绦虫[1]，人是其感染的最终宿主，主要通过误食虫卵或节片所致，多寄生于人体平滑肌、心脏、骨骼肌，偶有寄生于舌肌、脑部等部位[2]，对寄生人体的损害也因部位及虫体数量不同而差别很大。人主要通过自体内感染、自体外感染及异体感染，临床上囊虫寄生食管黏膜者少见。机体感染囊虫病后可出现多种并发症，消化道囊虫病可致消化道梗阻、恶心、呕吐、黄疸、消瘦、食欲不振及贫血，脑囊虫病可致癫痫发作。临床往往因症状不典型而误诊或漏诊，目前关于囊虫病的诊断最理想的方法是虫体活检[3]，主要以手术取出虫体及药物吡喹酮驱虫治疗[4-5]，但囊虫病的预防显得更为重要，注意饮食卫生、不吃生食、保证上市猪肉安全才是囊虫病根本的防治措施。

[1]姚立新, 邹文远, 钱万科, 等. 脑囊虫病的病理与磁共振成像表现[J]. 新乡医学院学报, 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]莫锋, 郭海城. 脑囊虫病的影像学分析[J]. 临床研究, 2013, 11(17): 200. Mo F, Guo HC. The imaging analysis of cerebral cysticercosis [J]. Guide of China Medicine, 2013, 11(17): 200.

[3]张春红. 中西医结合治愈猪肉绦虫病25例体会[J]. 医学理论与实践, 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]周国兴．寄生虫病药物手册[M]. 成都: 科技大学出版社, 1990: 87. Zhou GX. Drug handbook of parasitic disease [M]. Chengdu: University of Science and Technology Press, 1990: 87. [5]李文英, 高泽明, 李长密. 大剂量吡喹酮治疗脑囊虫病717例分析[J]. 中国误诊学杂志, 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.

(责任编辑：马 军)

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

贾金虎，硕士,研究方向：呼吸、消化病的诊治。E-mail: jiajinhu1987@163.com

10.3969/j.issn.1006-5709.2016.08.013

个案报道

R571

B

1006-5709(2016)08-0888-01

2015-12-21