成人脑室-腹腔分流术后的晚期感染并发症(4例报告并文献复习)  

Advanced infection as a complication of ventriculoperitoneal shunt in adults (a report of 4 cases and review of literature)

作　　者：陈亦豪 徐宵寒 魏俊吉[1] 赵一鸣[3] 吴昊[1] 马百涛 常健博 王任直[1] 马文斌[1] CHEN Yi-hao;XU Xiao-han;WEI Jun-ji(Department of Neurosurgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院,北京协和医院神经外科,北京100730 [2]中国医学科学院北京协和医学院,北京协和医院麻醉科,北京100730 [3]中国医学科学院北京协和医学院,北京协和医院基本外科,北京100730

出　　处：《临床神经外科杂志》2019年第2期176-180,184,共6页Journal of Clinical Neurosurgery

基　　金：国家重点研发计划(2018YFA0108603)

摘　　要：目的探讨成人脑室-腹腔分流术后晚期感染并发症的临床特点及治疗措施。方法回顾性分析北京协和医院神经外科收治的4例脑积水术后感染患者的临床资料。对术后出现腹腔源性感染及多发感染并发症进行分析,并复习相关文献,总结其临床特点。结果 4例术后晚期感染者均为交通性脑积水行脑室-腹腔分流术后患者。其中2例患者表现为粘连性肠梗阻、1例患者为多发腹腔内脓肿,1例患者为肺部及泌尿系感染,均合并颅内感染。经拔除脑室-腹腔分流管、抗生素治疗后感染均得到控制,后期行二次分流手术,疗效满意出院。随访6个月以上,4例患者均无感染复发。结论脑室-腹腔分流术后晚期感染,尤其腹腔源性感染临床相对少见,并常合并颅内感染。其治疗过程复杂,持续引流及系统性抗生素治疗是关键。Objective To explore clinical characteristics,prevention and treatment of advanced infection as a complication of ventriculoperitoneal (VP) shunt.Methods The clinical data of 4 patients with hydrocephalus underwent VP shunt admitted in Peking Union Medical College Hospital were analyzed retrospectively. Results 3 cases of abdominal infection and 1 of multisystemic infection were presented,all of which were patients developing hydrocephalus after neurosurgery.2 of them were cases of adhesive intestinal obstruction and intracranial infection,1 case was multiple abdominal abscesses,while the other one was a case of intracranial infection combined with urinary tract infection and pulmonary infection.These 4 patients were treated effectively by shunt removal and intravenous administration of antibiotics and there was no relapse during the 6-month follow-up. Conclusions VP-shunt related advanced infection has non-specific clinical manifestations and is often associated with intracranial infection.Staphylococcus is one of the major pathogens.Shunt removal or externalization and systematic antibiotics treatment is usually required.

关 键 词：脑积水 脑室-腹腔分流术 腹腔感染 颅内感染 粘连性肠梗阻 

分 类 号：R651.1[医药卫生—外科学]