内镜下脑室灌洗治疗脑室感染
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内镜下脑室灌洗治疗脑室感染
肖庆 陈国强 郑佳平 武晋廷 梁晖 黄乙洋 左焕琮 中国医科大学航空总医院神经外科肖庆
摘 要:目的 探讨软性神经内镜下脑室灌洗治疗脑室感染的效果.方法 自2007年2月至2009年11月,应用电子软性神经内镜对60例脑室感染患者行脑室灌洗治疗.结果 一次性内镜下脑室灌洗治愈脑室感染并成功去除脑室外引流或分流26例,占43%;内镜下脑室灌洗后继续脑室外引流并脑室内应用抗生素34例,占57%;脑室外引流时间为4-76 d,平均20.1 d.其中去除脑室外引流后仍有颅内压增高需再次脑室-腹腔分流者7例,占12%;死亡5例,均为广泛耐药的绿脓杆菌和真菌感染,死亡率8%.结论 脑室感染是神经外科临床中的一个棘手问题,软性神经内镜下脑室灌洗治疗脑室感染可提高治疗效果.
关键词:神经内镜;脑室灌洗;脑室感染
Endoscopic ventricular irrigation for treatment of ventricular infection
XIAO Qing(Department of Neurosurgery, Yuquan Hospital, Tsinghua University, Beijing 100049, China) CHEN Guo-qiang(Department of Neurosurgery, Yuquan Hospital, Tsinghua University, Beijing 100049, China) ZHENG Jia-ping(Department of Neurosurgery, Yuquan Hospital, Tsinghua University, Beijing 100049, China) WU Jin-ting(Department of Neurosurgery, Yuquan Hospital, Tsinghua University, Beijing 100049, China) LIANG Hui(Department of Neurosurgery, Yuquan Hospital, Tsinghua University, Beijing 100049, China) HUANG Yi-yang(Department of Neurosurgery, Yuquan Hospital, Tsinghua University, Beijing 100049, China) ZUO Huan-cong
Abstract:Objective To study the effect of endoscopic ventricular irrigation for the treatment of ventricular infection. Methods 60 cases of ventricular infection were treated with endoscopic ventricular irrigation under flexible neuron-endoscope from Febrary, 2007 to November,2009. Among them, 41 cases were secondary to V-P shunt, 13 cases were secondary to external ventricular drainage due to intraventricular hemorrhage or traumatic hydrocephalus, 4 cases were secondary to other neurosurgical operations and 2 case was due to tuberculous meningitis. Results Of all the 60 patients, 25 (42%) were negative in CSF bacterial culture, 27(45%) were infected with general pyogenic bacteria such as staphylococci, streptococcus pneumoniae, Enterococcus faecalis, Klebsiella pneumoniae, Escherichia coli,Acinetobacter baumannii. 3(5%) were infected with Pseudomonas aeruginosa, 3(5%) were fungal infection, 2(3%) were infected with tubercle bacillus. 26(43%) cases of ventricular infection were cured with successful removal of shunt or external ventricular drainage (EVD) by single endoscopic ventricular irrigation. 34(57%) patients whose endoscopic ventricular irrigation were followed by EVD andintraventricular injection of antibiotics, the EVD duration was 4 to 76 d (mean 20.1 d). The second V-P shunt was not avoided due to intracranial hypertension after removal of EVD in 7 (12%) patients. The death rate was 8%. All dead cases were infected with Pseudomonas aeruginosa or fungus which were extensive drug -resistant. Conclusion Severe ventricular infection is troublesome in neurosurgery. Ventricular irrigation under flexible neuron-endoscope could shorten the course and improve the effect of the treatment of severe ventricular infection.
Keywords:Neuroendoscopy;Ventricular irrigation;Ventricular infection
作者单位:肖庆(100049,北京,清华大学玉泉医院神经外科)
陈国强(100049,北京,清华大学玉泉医院神经外科)
郑佳平(100049,北京,清华大学玉泉医院神经外科)
武晋廷(100049,北京,清华大学玉泉医院神经外科)
梁晖(100049,北京,清华大学玉泉医院神经外科)
黄乙洋(100049,北京,清华大学玉泉医院神经外科)
左焕琮(清华大学生命科学与医学研究院脑神经疾病研究所)
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本文全文发表在中华神经外科杂志
CHINESE JOURNAL OF NEUROSURGERY
2010 Vol.26 No.8 P.706-708