采用神经内镜技术诊疗脑室系统感染  

Application of endoscopic neurosurgery in diagnosis and treatment of ventriculitis

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] 崔凤启 幸兵[2] 刘滨 戴缤[1] 朱广通[1] 肖智勇[1] 毛贝贝[1] Guan Feng;Hu Zhiqiang;Huang Hui;Ren Zuyuan;Wang Zhenyu;Fu Jidi;Li Yingbin;Cui Fengqi;Xing Bing;Liu Bin;Dai Bin;Zhu Guangtong;Xiao Zhiyong;Mao Beibei(Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China)

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]中国医学科学院北京协和医学院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 [6]北京房山区良乡医院神经外科

出　　处：《中华神经外科杂志》2018年第6期559-563,共5页Chinese Journal of Neurosurgery

摘　　要：目的 探讨神经内镜技术在诊断和治疗脑室系统感染中的作用.方法 回顾性分析首都医科大学附属北京世纪坛医院神经外科等6家医院神经外科2010年3月至2017年3月采用神经内镜诊疗的21例脑室系统感染患者的临床资料.术中根据脑室感染的程度将患者分为Ⅰ～Ⅳ型.术中打通脑室内分隔重建脑脊液循环,清除脑室内的炎性沉渣、条索、被覆物及血块,撤除人工植入材料.术后根据脑室感染分型及细菌培养结果给予脑室内抗生素用药.继发性脑积水患者择期行第三脑室底造瘘术（ETV）或脑室-腹腔分流术.结果 21例患者中,Ⅰ型感染6例,Ⅱ型7例,Ⅲ型4例,Ⅳ型4例.20例（95.2％）治愈,1例（4.8％）死于多脏器功能衰竭.16例脑室系统感染继发脑积水者中,11例行脑室-腹腔分流术,5例行ETV治疗（其中1例无效后再行脑室-腹腔分流术）.均未发生手术相关的严重并发症.随访时间中位数为25.5个月（5～ 60个月）,脑室感染无反复,脑积水疗效较好.结论 神经内镜技术可以有效地诊断、评估和治疗脑室系统感染.围手术期脑室内抗生素用药对治愈脑室系统感染发挥重要的作用.Objective To explore the role of endoscopic neurosurgery in the diagnosis and treatment of ventriculitis.Methods A retrospective study was conducted on the clinical data of 21 patients with ventriculitis who underwent neuroendoscopic diagnosis and treatment at 6 medical center including Department of Neurosurgery,Beijing Shijitan Hospital,Capital Medical University from March 2010 to March 2017.Infection of the ventricular system was divided into Ⅰ-Ⅳ types based on the neuroendoscopic assessment.Neuroendoscopic surgical techniques was applied to incise the intraventricular compartment and reconstruct cerebrospinal fluid circulation,obliterate intraventricular debris and pus and remove artificial implanted materials.Perioperatively intraventricular antibiotics were administered according to the type of infection and the results of bacterial culture.Endoscopic third ventriculostomy （ETV） or ventriculoperitoneal shunt was performed for secondary hydrocephalus.Results There were 6 cases of type Ⅰ,7 cases of type Ⅱ,4 cases of type Ⅲ and 4 cases of type Ⅳ.One （4.8%） died of multiple organ failure.Twenty （95.2%） cases of ventriculitis fully recovered.Among the 16 cases with secondary hydrocephalus,11 cases underwent ventriculoperitoneal shunt and 5 cases underwent ETV.ETV was ineffective in 1 case and ventriculoperitoneal shunt was then performed for the case.During the follow-up with a median of 25.5 months （5-60 months）,there was no recurrence and the surgical effects were satisfactory.Conclusions Application of neuroendoscopic techniques seem effective for the diagnosis,assessment and treatment of ventriculitis.In addition,perioperative lavage of the ventricular system with antibiotic saline might be of importance.

关 键 词：自然腔道内镜手术 脑室 感染 诊断 治疗 

分 类 号：R651.1[医药卫生—外科学]