开颅手术和CT定位立体定向穿刺术治疗脑脓肿的操作技巧及体会  

Study on techniques of open craniotomy and CT-guided stereotactic puncture in treatment of patients with brain abscess

作　　者：任力[1] 赵亮[1] 王之涵[1] 徐豪[1] 周新军[1] 韩东华[1] 沙龙贵[1] 黄焕斌[1] 

机构地区：[1]复旦大学附属浦东医院神经外科,上海201399

出　　处：《实用临床医药杂志》2016年第13期19-21,共3页Journal of Clinical Medicine in Practice

基　　金：上海市浦东新区卫生和计划委员会科技发展专项基金(PW2013A-19);上海市浦东新区卫生系统重点专科建设资助项目(PWZz2013-18)

摘　　要：目的 探讨开颅手术和CT定位下立体定向穿刺手术在脑脓肿治疗中的应用效果,总结相关手术技巧。方法 回顾性分析39例脑脓肿患者临床资料,其中24例行开颅手术,15例行CT定位下立体定向穿刺术,术后均给予抗生素治疗。结果39例患者手术顺利,出院时临床症状消失或明显改善,头颅CT或MRI复查显示脓肿腔消失。随访3个月-2年,1例患者颅底MRI检查显示部分斑点状强化影,经抗生素规范治疗6周后复查症状消失。其余患者未见脓肿复发,无手术相关并发症。结论 脑脓肿治疗方案选择应结合术前脓肿病变特点和患者个体状况,CT定位下立体定向穿刺术是一种安全、有效的微创治疗方法。Objective To investigate the effect of open craniotomy and CT-guided stereotactic puncture on treatment of patients with brain abscess and to summarize related surgical techniques. Methods The clinical features and diagnostic data of 39 patients with brain abscess were retrospectively analyzed. Of 39 patients, 24 cases were treated with open craniotomy and 15 cases were treated by CT-guided stereotactic puncture. All patients received antibiotic therapy after operation. Results All patients had obvious improvements of clinical symptoms at discharge. CT or MRI re-examination showed the disappearance or obviously diminution of abscess in all patients. The MRI scan showed small dot-like shadow in one patient during follow-up （ranging from 3 months to 2 years）, who was cured by antibiotic treatment for 6 weeks. No recurrence of brain abscess or surgery-related complications were observed. Conclusion The pathologic features of brain abscess and individual conditions should be considered in therapeutic options selection. CT-guided stereotactic puncture is an effective and safe way for treating brain abscess.

关 键 词：脑脓肿 立体定向穿刺 开颅手术 抗生素 

分 类 号：R742[医药卫生—神经病学与精神病学]