脑脓肿302例临床治疗经验总结

摘要

目的：比较不同时期脑脓肿的诊疗经验和预后。方法回顾性分析1980—2014年天津医科大学总医院神经外科收治的302例脑脓肿患者的临床资料。男性215例，女性87例，年龄11～82岁，平均年龄（30±8）岁。根据诊断和治疗方法将患者分为1980—2001组和2002—2014组。治疗方法包括手术治疗和药物保守治疗，其中手术治疗患者196例（单纯切除95例，穿刺引流89例，穿刺引流后切除12例），药物保守治疗106例。采用χ2检验比较两组患者的一般资料、感染因素、临床表现和体征、脓肿部位和治疗效果等。结果与1980—2001组相比，2002—2014组脑脓肿患者感染因素中邻近部位感染比例下降（χ2＝8�000，P＝0�005）；单发脓肿比例下降，多发脓肿比例升高（χ2＝11�060，P＝0�001）；额叶、颞叶部位感染比例下降（χ2＝9�080，P＝0�003；χ2＝15�440，P＝0�000）；头痛、呕吐症状比例下降（χ2＝23�290，P ＝0�000；χ2＝21�020，P＝0�000），视乳头水肿比例下降（χ2＝2�290，P＝0�001）；细菌培养阳性率比例下降（χ2＝50�280，P＝0�000），差异均有统计学意义。1980—2001组和2002—2014组病死例数分别为23例（10�4％）和5例（6�3％），差异无统计学意义（χ2＝1�180，P＝0�277）；两组术后病死例数分别为21例（14�4％）和2例（4�0％），差异有统计学意义（χ2＝3�880，P＝0�049）。结论随着抗菌药物、影像技术不断更新及显微手术的不断发展，脑脓肿患者的预后得到了改善。%Objective To compare the diagnosis and treatment experience of brain abscesses and improve prognosis� Methods The data of 302 patients of brain abscess at Department of Neurosurgery in Tianjin Medical University General Hospital from 1980 to 2014 was analyzed retrospectively� There were 215 male and 87 female patients aged from 11 to 82 years with mean age of (30±8) years� The patients was divided into 1980-2001 group and 2002-2014 group according to different diagnosis and the treatment methods� The therapy methods include operation and conservative treatment� There were 196 cases received operation, including 95 cases of excision, 89 cases of ventriculopuncture, 12 cases of excision after ventriculopuncture, 106 cases received drug conservative therapy� Two groups of information including clinical manifestation, abscess location, therapeutic effect and prognosis were compared by χ2 test�Results Compared to 1980-2001 group,adjacent infection incidence declined(χ2=8�000,P=0�005)�The ratio of single abscess declined and multiple abscess increased(χ2=11�060,P=0�001),the infection proportion of frontal lobe and temporal lobe decreased(χ2=9�080,P=0�003;χ2=15�440,P=0�000)� The ratio of headache and vomit and papilledema declined significantly(χ2=23�290,P=0�000;χ2=21�020,P=0�000;χ2=2�290,P=0�001)� Total mortality of 302 patients were 23 cases and 5 cases of 1980-2001 group and 2002-2014 group (10�4% vs� 6�3%,χ2=1�180,P=0�277)� However,there were statistical difference in postoperative mortality between both groups ( 14�4% vs� 4�0%,χ2 =3�880, P=0�049 )�Conclusion With the application of antibiotics and the development of neurosurgical techniques, the prognosis of brain abscess has been improved.