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

基金项目：清华-裕元医学科学研究基金资助(202400567)
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

http://elec.wanfangdata.com.cn/qikan/periodical.articles/zhsjwkzz98/zhsj2010/1008/100815.htm