脑室系统感染的神经内镜诊疗策略  

Strategy of neuroendoscopic diagnosis and treatment for ventricular system infection

作　　者：关峰[1] 胡志强[1] 黄辉[1] 任祖渊[2] 王振宇[3] 傅继弟[4] 李英斌[5] 刘彬[3] 幸兵[2] 朱广通[1] 毛贝贝[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院神经外科,100038 [2]北京协和医院神经外科 [3]北京大学第三医院神经外科 [4]首都医科大学附属北京同仁医院神经外科 [5]南京医科大学附属第二医院神经外科

出　　处：《中华神经外科杂志》2014年第4期377-380,共4页Chinese Journal of Neurosurgery

基　　金：首都卫生发展科研专项项目（2011-2008-06）;首都临床特色应用研究（z131107002213044）

摘　　要：目的探讨脑室系统感染的神经内镜诊疗策略。方法应用神经内镜诊疗14例脑室系统感染，观察和评估脑室内感染程度，清除脑室内沉渣和附壁脓苔，贯通脑室内分隔，游离被脉络丛或炎性纤维条索包裹的分流管，切除脑室内脓肿或行脓肿囊壁开窗引流术，留置双侧脑室外引流管，术后脑室内抗生素盐水持续灌注冲洗，时间为2—4周，合并脑积水的患者再行脑脊液转流术治疗。结果1例因肺部感染、呼吸衰竭最终死亡，其余13例均治愈。9例合并脑积水的患者中，5例行脑室-腹腔分流术，3例行第三脑室底造瘘术（ETV），1例ETV治疗无效后再行脑室-腹腔分流术。住院时间1-14个月，平均3．2个月。随访5～22个月，脑室系统感染无反复，1例脑室-腹腔分流术后出现孤立性第四脑室，再行ETV和中脑导水管成形术，其余患者疗效满意。结论神经内镜为脑室系统感染的诊疗提供了有效方法和新思路，围手术期抗生素盐水脑室内持续灌洗，对彻底纠正脑室内感染也起到非常重要的作用。Objective To investigate the strategy of neuroendoscopic diagnosis and treatment for ventricular system infection. Methods 14 patients with ventricular system infection were diagnosed and treated with neuroendoscopy. The procedures of neurocndoscopic operation included the observation and evaluation of the degree of ventricular infection, clearance of pus moss and sediment, perforation of septation, dissociation of shunt adhered to choroid plexus and cellulose, resection and drainage of ventricular abscess. Perfusion and rinsing in ventricular system were performed with antibiotics salt water during 2 -4 weeks after operation. The third ventriculostomy or ventriculoperitoneal shunt was performed for hydrocephalus with ventricular infection. Results One patient was dead of pulmonary infection and respiratory failure. 13 cases with ventrieular system infection were completely cured. In 9 cases of hydrocephalus with ventrieular infection, 5 cases performed ventriculoperitoneal shunt, 3 endoscopic third ventriculostomy, and one after failed endoscopic third ventriculostomy performed ventriculoperitoneal shunt. The period of staying in hospital was from 1 to 14 months （ 3.2 months in average）. During the follow - up period, the curative effect of the operation was satisfactory. Conclusions With neuroendoscopic observation and evaluation of the degree of ventricular infection and application of ncuroendoscopic operative method was a new method and effective management for ventricular system infectiorL Perfusion and rinsing in ventricular system with antibiotics salt water were also very important.

关 键 词：神经内镜 脑室 感染 脑室内脓肿 脑积水 

分 类 号：R651.1[医药卫生—外科学]