显微外科联合神经内镜经鼻手术治疗开颅术后额窦感染的临床疗效  

Treatment outcome of frontal sinus infection post craniotomy by microsurgery combined with transnasal endoscopic surgery

作　　者：徐勇[1] 邱锷[1] 李永[1] 张天明[1] 康军[1] Xu Yong;Qiu E;Li Yong;Zhang Tianming;Kang Jun(Department of Neurosurgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院神经外科,100730

出　　处：《中华神经外科杂志》2020年第11期1156-1159,共4页Chinese Journal of Neurosurgery

基　　金：北京市科委首都市民健康培养项目(Z151100003915153)。

摘　　要：目的探讨开颅术后额窦感染的病因以及采用显微外科联合神经内镜经鼻手术治疗的临床疗效。方法回顾性分析2015年1月至2019年12月首都医科大学附属北京同仁医院神经外科收治的20例开颅术后额窦感染患者的临床资料,患者均采用显微外科联合神经内镜经鼻手术治疗。分析开颅术后额窦感染的可能病因、术中情况及疗效。结果20例患者术中均可见额窦引流通路堵塞,其中人工材料堵塞12例,骨质畸形愈合6例,瘢痕形成堵塞2例。术中留取脓液细菌培养阳性者13例,其中金黄色葡萄球菌8例,星座链球菌3例、阴沟肠杆菌1例、铜绿假单胞菌1例。20例患者术后中位随访时间为21个月(6个月至5年),患者头皮切口及皮肤窦道伤口均愈合,颅内、鼻腔均未见迟发性感染征象。结论开颅术后额窦感染多见于鼻窦内人工异物残留及引流通路不畅;显微外科联合神经内镜经鼻手术治疗有利于彻底清除感染灶并使鼻窦引流通畅,有助于患者的预后。Objective To investigate the causes of frontal sinus infection post craniotomy and its treatment outcome of microsurgery combined with transnasal endoscopic surgery.Methods The clinical data of 20 patients admitted to Neurosurgery Department of Beijing Tongren Hospital,Capital Medical University from January 2015 to December 2019 were retrospectively analyzed.All 20 patients underwent microsurgery combined with transnasal endoscopic surgery.The possible causes,intraoperative conditions and therapeutic outcomes of frontal sinus infection post craniotomy were analyzed.Results Obstruction of frontal sinus drainage pathway was observed during the operation of all 20 patients.The obstruction was due to artificial materials in 12 cases,bone malunion in 6 cases,and formation of scar in 2 cases.There were 13 positive cases of microbial culture in pus obtained during operation,including 8 cases of Staphylococcus aureus,3 cases of Streptococcus constellation,1 case of Enterobacter cloacae and 1 case of Pseudomonas aeruginosa.The 20 patients were followed up for 6 months to 5 years after surgery,and the median follow-up time was 21 months.The patient's scalp incision and skin sinus wounds were healed,and there were no signs of delayed infection in the skull or nasal cavity.Conclusion Frontal sinus infection is mainly seen in the patients with residual of artificial foreign body in the sinuses and the obstruction of drainage pathway after craniotomy.The combined treatment of microsurgery and transnasal endoscopic surgery could facilitate the removal of infectious lesion and drainage of the sinuses,which is helpful for the patient’s recovery.

关 键 词：额窦 感染 手术后并发症 显微外科手术 自然腔道内镜手术 

分 类 号：R651.1[医药卫生—外科学]