梅毒性神经系统树胶肿的非手术治疗研究

发布时间：2018-03-21 20:04

本文选题：神经梅毒　切入点：树胶肿　出处：《苏州大学》2010年硕士论文　论文类型：学位论文

【摘要】： 目的:探讨梅毒性神经系统树胶肿的非手术治疗的临床疗效,进一步提高临床对该病的诊疗水平。方法:回顾性分析6例梅毒性神经系统树胶肿患者的临床资料、实验室检查和影像学检查结果及诊疗过程,临床转归及随访资料。结果:①梅毒性神经系统树胶肿患者临床表现主要为头痛;②患者血清和脑脊液梅毒学检查为阳性,脑脊液细胞数和蛋白含量偏高;③患者CT和MRI表现为占位病变,MRI T1WI表现为低信号,T2WI表现为高信号,增强后病灶中央呈结节状强化,病灶周围有水肿;④梅毒性神经系统树胶肿的病理表现为血管内皮、血管明显增生,大量以浆细胞为主的炎性细胞浸润,不一定有坏死;⑤梅毒性颅内树胶肿容易误诊为颅内肿瘤,通常手术治疗;⑥手术组3例患者术后行药物驱梅治疗后临床完全恢复,非手术组的2例颅内树胶肿患者行药物驱梅治疗后临床也完全恢复,脊髓树胶肿非手术治疗后临床得到明显改善。结论:梅毒性神经系统树胶肿的诊断需结合梅毒感染史、临床表现、实验室及影像学检查综合分析;影像学主要表现为占位病变,周边水肿,增强扫描可见强化;非紧急情况下非手术治疗是梅毒性神经系统树胶肿的首选方法,临床疗效显著,并可以避免各种手术的并发症;驱梅治疗首选水剂青霉素,也可联合糖皮质激素治疗;梅毒性脊髓树胶肿非手术治疗的临床疗效较颅内树胶肿稍差。
[Abstract]:Objective: to investigate the clinical effect of non-operative treatment of syringomelopathy of nervous system and to improve the clinical diagnosis and treatment of the disease. Methods: the clinical data, laboratory and imaging findings, diagnosis and treatment process, clinical outcome and follow-up data of 6 cases of syphilis nerve system gum swelling were retrospectively analyzed. Results the clinical manifestations of the patients with syphilis of the syphilis of the syphilis in the serum and cerebrospinal fluid of the patients with syphilis were positive. The CT and MRI findings of cerebrospinal fluid (CSF) with high cell count and protein content were as follows: Mr T1WI showed low signal intensity on T _ 2WI and nodular enhancement in the center of the lesion after contrast enhancement. The pathological features of the edema around the lesions were vascular endothelium, obvious proliferation of blood vessels, a large number of inflammatory cells infiltrated mainly by plasma cells, and not necessarily necrotic and syphilis toxic intracranial gum swelling, which were easily misdiagnosed as intracranial tumors. The clinical data of 3 patients in the operation group and 2 patients in the non-operative group were completely recovered after the drug treatment, and the patients in the non-operative group were treated with the drug repellent therapy, and the patients in the non-operative group were treated with drug repellent therapy. After non-operative treatment of spinal cord gum, the clinical results were significantly improved. Conclusion: the diagnosis of syphilis infection, clinical manifestation, laboratory and imaging examination should be combined with the diagnosis of syphilis infection. Non-operative treatment is the first choice method for syringomelopathy of nervous system, and the clinical effect is remarkable, and can avoid the complications of all kinds of surgery, the water agent penicillin is the first choice in the treatment of plum repellent, it can also be combined with glucocorticoid treatment. The clinical effect of non-operative treatment of syphilis spinal cord gum was slightly worse than that of intracranial gum.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R759.1

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