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  4. the treatment of lung echinococcosis, what to do with lung echinococcosis, medication

the treatment of lung echinococcosis, what to do with lung echinococcosis, medication

the treatment of lung echinococcosis, what to do with lung echinococcosis, medication

Knowledge of diagnosis and treatment of pulmonary hydatid disease

Treatment department: Cardiothoracic Surgery Department of Infectious Diseases Treatment cost: about (5000-20000 yuan) in the city's top three hospitals Cure rate: Treatment cycle: Treatment method: Drug treatment General treatment of pulmonary hydatid disease

Western medicine treatment of lung echinococcosis

One, treatment

Lung hydatid cysts generally grow progressively, and very few can "self-heal". Sooner or later, most of them will rupture due to the increased pressure in the cyst, causing serious complications. There are often treatments such as surgery, puncture, and drugs. Drug therapy has become an important auxiliary means of surgical treatment or only for patients with multiple cysts that cannot be operated on. Commonly used drugs include albendazole, albendazole, mebendazole and praziquantel, etc., which can make the germinal layer and the original head The larvae degenerate and deteriorate, and some cysts stop growing or shrinking. They can also be used before surgery to reduce postoperative recurrence. Surgical removal of hydatid cysts is the first choice for the treatment of echinococcus, and it is also the most commonly used treatment at present.

The surgical method is determined according to the size, number, location, presence or absence of concurrent infection and whether the pleura is adhered to the cyst. The main surgical methods are internal capsule removal and lobectomy. The main point of the operation is to prevent the cyst from rupturing and the cyst fluid overflows into the thoracic cavity or the soft tissues of the chest wall, which can cause hydatid disease to spread or allergic reactions. In order to prevent anaphylactic shock caused by the rupture of the cyst and the overflow of cyst fluid into the thoracic cavity during the operation, hydrocortisone 100mg or dexamethasone 10mg can be infused intravenously before the operation.

Surgical methods:

1. Complete removal of internal capsule

After opening the chest to separate the adhesions, because the cysts are mostly near the periphery, a fibrin layer covering the lung surface can sometimes be seen. Before removal, fill and cover the lungs with gauze, exposing only the part where the capsule is to be taken out of the incision, and prepare a suction device with strong suction to facilitate the timely suction of the contents in the case of accidental rupture of the capsule to avoid contaminating the chest cavity. Then carefully incise the pulmonary fibrous layer around the cyst, with the knife slightly tilted to avoid cutting into the inner capsule perpendicularly. Due to the high pressure of the inner capsule, after a small incision in the outer capsule, the white inner capsule wall can be seen bulging from the incision, extending the incision. Ask the anesthesiologist to inflate the inner capsule with the help of lung pressure. Generally, because there is no adhesion between the inner and outer capsules, the cyst cavity can be completely removed. After the internal capsule is taken out, there is a leak in the bronchiolar opening on the external capsule. It is firstly blocked with gauze, and then sutured to repair. More of the residual cavity wall can be removed or inverted, and then sutured to completely eliminate the residual cavity.

2. The surgical indications for internal capsule puncture removal are:

①The hydatid cyst has been obviously infected and has complications, such as: there is a star-shaped translucent area on the top of the outer capsule; the inner and outer capsules are ruptured, and there is a liquid level;

②The above methods are more suitable for areas where the basic skills are not solid and the operation is not proficient. After tightly protecting the area around the cyst with gauze, puncture with a thick needle to draw out the fluid in the cyst cavity, then cut the outer cavity, clamp and lift the outer cyst wall next to the incision, continue to suck up the cyst fluid, and remove The collapsed internal capsule is clamped out. The residual cavity is wiped with alcohol gauze or washed with hydrogen peroxide to kill the protocercaria. Formaldehyde was often used in the past to apply formaldehyde, which may cause severe bronchospasm when entering the bronchial leak. It is no longer used. If there is bronchial air leakage in the residual cavity, it should be sutured one by one, and then the whole layer (larger can be divided into several times) from the periphery to the bottom to eliminate the residual cavity.

3. Lung resection

It is used for patients whose cysts have ruptured, lung tissues have serious infections, bronchiectasis, pulmonary fibrosis, empyema, bronchopleural fistula or lung cancer cannot be excluded. If possible during the operation, it is best to free the bronchus first and clamp it to avoid that the cyst cavity breaks to the bronchus when the lung tissue is squeezed during the operation, causing the disease to spread or suffocate and die. The presence of fistula external cyst wall edema or large cyst causes severe necrosis of the lung tissue in this lobe; larger cysts that are confined to the cyst wall of the outer lobe or calcification and are not easy to collapse or cysts secondary infection form chronic thick-walled abscesses, etc., can be considered for lung Partial resection or lobectomy.

4. Treatment of special types of hydatid disease

If there are liver and lung cysts at the same time, one operation can be performed. If there are bilateral lesions, the side with larger lesions or complications should be treated first. If the lung cyst has bronchopleural fistula, the closed citation should be done first.

After the infection is controlled and the physical strength is restored, lung resection will be performed.

2. Prognosis

The prognosis of this disease is good, but the prognosis is poor for those with shock due to rupture of hydatid. Common causes of recurrence:

①Small hydatid cysts are left during the operation;

②Intraoperative sac fluid overflow, scalp detachment, transplantation recurrence;

③Re-infection and relapsed patients underwent re-pulmonary resection, and the effect was much better.

Differentiation and Treatment of Pulmonary Hydatid Disease

TCM treatment of pulmonary hydatid disease

Insect poison in the lungs and chest, chest pain, bloody sputum, fatigue, night sweats, fever, sputum, or pleural fluid. Ringworm of the tongue, greasy moss, slippery pulse. [Therapeutic method] Open the chest to clear the knots, strengthen the body and eliminate evil.

[Recipe] Adding Phlegm Decoction: Danshen 30g, Astragalus 13g, Artemisia annua 12g, Turtle Carapace 13g, Scutellaria Baicalensis 12g, Platycodon 45g, Tangerine Peel 45g, Pinellia 45g, Poria 13g, Dannanxing 7 grams, 12 grams of Citrus aurantium, 6 grams of licorice, 12 grams of Lei Wan powder (red). For those with fever and coughing up sputum, add 30 grams of reed stems, 12 grams of winter melon kernels, 13 grams of houttuynia cordata, and pleural fluid with Tinglizi 4s grams, 6 jujubes.

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