先天性皮毛窦合并中枢神经系统感染的外科治疗  

Surgical treatment of congenital dermal sinus combined with the central nervous system infection

作　　者：高干 尚爱加[1] 白少聪 陶本章 李士强 孙梦纯 Gao Gan;Shang Aijia;Bai Shaocong;Tao Benzhang;Li Shiqiang;Sun Mengchun(Department of Neurosurgery,First Medical Center of Chinese PLA General Hospital,Beijing 100853,China;Department of Neurosurgery,PLA 960th Hospital,Taian 271000,China)

机构地区：[1]解放军总医院第一医学中心神经外科,北京100853 [2]解放军第九六○医院泰安院区神经外科,山东271000

出　　处：《中华神经外科杂志》2020年第6期579-583,共5页Chinese Journal of Neurosurgery

基　　金：首都临床特色应用研究课题(Z171100001017140);解放军总医院科技创新苗圃基金(17KMM11)。

摘　　要：目的探讨先天性皮毛窦合并中枢神经系统感染的外科治疗方法及其疗效。方法回顾性分析2014年1月至2019年1月解放军总医院第一医学中心神经外科收治的15例先天性皮毛窦合并中枢神经系统感染患者的临床资料。所有患者均在明确诊断后,早期予手术联合术后抗炎治疗。术后根据临床症状和实验室检查结果评估感染控制效果,采用脊柱裂神经功能量表(SBNS)评估患者神经功能的改善情况。结果15例患者均完整切除皮毛窦,合并的脊髓拴系等疾病处理满意。1例患者术后出现刀口愈合不良,余14例患者无一例出现手术相关并发症。所有患者术后随访6~66个月,中位时间为23个月。术后感染均得到有效控制。术后无一例病灶复发。SBNS评估结果表明,术前的神经功能障碍相关症状均有不同程度的改善,术后末次随访时的SBNS中位评分(上、下四分位数)高于术前[分别为15(13,15)分和13(11,15)分],两者的差异有统计学意义(Z=-2.699,P=0.007)。结论对于先天性皮毛窦合并中枢神经系统感染患者,通过早期手术,彻底清除感染灶联合针对性药物抗炎治疗,可有效控制感染,术后并发症少。Objective To investigate the surgical treatment and its efficacy of congenital dermal sinus combined with the central nervous system(CNS)infection.Methods A retrospective review was conducted on the clinical data of 15 cases of congenital dermal sinus combined with the CNS infection admitted to Department of Neurosurgery,First Medical Center of Chinese PLA General Hospital from January 2014 to January 2019.Once the diagnosis was confirmed,all cases underwent early surgery combined with postoperative anti-infection therapy.Efficacy of anti-infection post operation was assessed based on the symptoms and results of laboratory tests.Spina bifida neurological scale(SBNS)was used to evaluate the patient’s improvement of neurological function.Results Congenital dermal sinuses in 15 cases were all completely resected and treatment outcomes of comorbidities such as spinal tethering were satisfactory.Poor wound healing occurred in 1 case.None of the 14 patients developed surgical related complications.Follow-up duration ranged from 6 to 66 months with a median of 23 months.Infection was effectively controlled in all 15 cases and no relapses occurred.The results based on SBNS showed that the symptoms associated with neurological dysfunction were relieved in all 15 cases to varying degrees.The median(P25,P75)of SBNS score at the latest follow-up post operation was 15(13,15)points,which was higher than that prior to operation[13(11,15)points](Z=-2.699,P=0.007).Conclusion Early surgical removal of infection lesion in combination with targeted antibiotic therapy proves to be an effective approach with few complications in the control of infection and treatment of congenital dermal sinus combined with CNS infection.

关 键 词：中枢神经系统感染 神经外科手术 先天性皮毛窦 治疗结果 脊髓拴系综合征 

分 类 号：R651[医药卫生—外科学]