脑脓肿的外科治疗  

Clinical treatment of brain abscess

作　　者：丁惠 王笑亮 潘灏 胡志刚 王汉东 DING Hui;WANG Xiao-liang;PAN Hao(Department of Neurosurgery,General Hospital of the Eastern War Zone,Nanjing 210002,China)

机构地区：[1]东部战区总医院神经外科,南京210002

出　　处：《临床神经外科杂志》2022年第5期557-560,共4页Journal of Clinical Neurosurgery

基　　金：东部战区总医院院内管理课题(2017013)。

摘　　要：目的 探讨脑脓肿的外科治疗经验,尤其是脓肿破入脑室的危重症患者的治疗策略。方法回顾性分析东部战区总医院神经外科从2008年1月—2020年12月收治的67例脑脓肿患者的临床资料,其中22例保守抗生素治疗,9例行脓肿穿刺术,35例行脓肿切除术。其中有5例为脓肿破入脑室的危重症患者,对其中2例行双侧脑室外引流,左右两侧脑室引流管抗生素水持续冲洗引流。结果 67例脑脓肿患者中脑脊液或脓液培养阳性率为34%,22例保守抗生素治疗患者中治愈率为81%,9例脓肿穿刺术患者治愈率为88%,35例行脓肿切除术患者治愈率为97%。本组5例脓肿破入脑室的危重症患者,2例采取双侧脑室冲洗引流者均治愈,其余3例单纯抗生素治疗或腰大池引流均预后不佳。随访时间3~6个月,有3例患者出现复发,后予以对症处理后均治愈良好。结论 脑脓肿患者辅以脓肿穿刺或切除等积极外科治疗可以取得更好的治疗效果,对于脑脓肿破入脑室的危重症患者,除了常规的抗生素治疗或手术外,保持双侧脑室外引流的持续冲洗和引流是至关重要的。Objective To explore the clinical treatment experience of brain abscess,especially the patients with abscess breaking into the ventricle.Methods The clinical data of 67 patients with brain abscesses admitted from January 2008 to December 2020 in the Department of Neurosurgery,General Hospital of the Eastern War Zone were analyzed retrospectively.22 were treated with antibiotics.9 with minimally invasive aspiration by means of a stereotactic frame.35 with total resection.2 with intraventricular rupture were treated by bilateral anterior horn of lateral ventricle catheterization hours continuous flushing with natural saline containing antibiotics and drainage.Results The positive rate of cerebrospinal fluid or pus culture was 34%.Curative rate of brain abscess with antibiotics was 81%.Curative rate of brain abscess with minimally invasive aspiration was 88%.Curative rate of brain abscess with total resection was 97%.2 cases with intraventricular rupture were cured which treated by bilateral anterior horn of lateral ventricle catheterization.Conclusions Patients with brain abscess can be better treated with more active surgical treatment such as abscess puncture or excision.In addition to routine antibiotic treatment or surgery,it is essential to maintain continuous irrigation and drainage of bilateral ventricular drainage.

关 键 词：脑脓肿 抗生素 脓肿穿刺 脓肿切除 双侧脑室外引流 

分 类 号：R651[医药卫生—外科学]