【文献解读】脑脓肿：162例手术经验
2018/2/26 创新医学网

    

    

     文章来源：欧尔意 OAE 微信号

     作者 :sofina

    

     原文出处

     Chowdhury FH, Haque MR, Sarkar MH, Chowdhury SM, Hossain Z, Ranjan S. Brain abscess: surgical experiences of 162 cases. Neuroimmunol Neuroinflammation 2015;2(3):153-61.

     DOI: 10.4103/2347-8659.160851

     摘要

     目的：尽管现代神经外科技术和抗生素已经问世，但脑脓肿依然是公共卫生面临的严峻挑战。本文阐述了我们的外科手术经验以及脑脓肿治疗的最终结果。方法：总计162例已被证实患有脑脓肿疾病并正在接受治疗的患者被纳入本次研究。文章对脑脓肿手术治疗中的前瞻性数据以及最终结果(通过格拉斯哥预后评分评定)分别进行了回顾性分析。结果：在162名患者中，113例为急性化脓性脓肿，49例为慢性脓肿。而在慢性脓肿患者中，有29例慢性化脓性脓肿，14例结核，3例曲霉菌和3例脓肿为恶性脑转移瘤。在急性病例中，常见的临床表现为头痛，发热，呕吐，局灶性损伤以及癫痫。在慢性脓肿，常见的临床表现为轻度至中度的头痛和渐进性局灶性损伤。73名73患者(45.06%)有相邻的局部鼻窦，中耳或颅内感染。常见的诱发因素包括脑神经术后，穿透性大脑损伤，慢性化脓性中耳炎，先天性心脏疾病，感染性心内膜炎，鼻窦炎和亚免疫状态。额叶涉及30.2%的患者，颞叶次之。111例患者(68.5%)进行单次头颅钻孔治疗，34例(21%)进行了两次或更多次头颅钻孔治疗。129例患者(79.62%)脓液培养为阴性。死亡22例(13.58%)。80.86%的患者出现脓肿完全消失且术前神经缺损完全恢复，5.55%的患者的主要的神经缺损得到恢复。在脑脓肿患者中入院时格拉斯哥昏迷量表(GCS)评分和死亡率之间有显著关联。结论：在大多数的情况下，脓液培养并没有造成任何致病微生物的生长。死亡率不直接与手术治疗相关，但入院时GCS评分与死亡率显著关联。早期诊断，最佳随访期和及时的手术治疗是脑脓肿治疗的关键。

     Aim: Brain abscess still poses a public health challenge in spite of the advent of modern neurosurgical techniques and antibiotics. Here, we present our surgical experiences and ultimate outcome in the management of brain abscess. Methods: Totally, 162 patients with proved brain abscess who underwent surgical treatment were included in this study. The prospectively recorded data of surgical management of brain abscess and the ultimate outcome (by Glasgow outcome scale) were studied retrospectively. Results: Total number of cases was 162, of which 113 were acute pyogenic abscess while 49 were chronic abscess. Among the chronic abscess, 29 were chronic pyogenic abscess, 14 were tubercular, 3 aspergillus, and 3 abscesses were in malignant brain metastases. In acute cases, common clinical features were headache, fever, vomiting, focal deficit and seizure. In chronic abscesses, common clinical features were mild to moderate headache and progressive focal deficit. Seventy-three (45.06%) patients had adjacent localized sinus, middle ear or cranial infection. The common predisposing factors included postneurosurgery, postpenetrating injury to brain, chronic suppurative otitis media, and congenital heart disease, infective endocarditis, sinusitis and sub optimum immuno-status. Frontal lobe involved in 30.2% cases, temporal lobe is next to involved. Single time burr hole aspiration in 111 (68.5%) cases, two or more times burr hole aspiration were done in 34 (21%) cases. Pus culture was negative in 129 (79.62%) cases. Total number of death was 22 (13.58%) cases. Complete resolution of abscess with complete recovery of preoperative neuro-deficit was seen in 80.86% cases and recovery with major neuro-deficit was observed in 5.55% cases. There is a significant association between Glasgow coma scale (GCS) on admission and mortality in brain abscess. Conclusion: In most of the cases, pus culture did not yield growth of any causative organism. Mortality was not directly related to surgical intervention, but GCS on admission has a significant association with mortality. Early diagnosis, optimum follow-up and timely surgical interventions are the keys in the proper management of brain abscess.

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