Wang Jingsheng,Wang Chong,Liu Qibin,et al.Efficacy evaluations of surgery for suppurative meningitis with subdural effusion and ventriculitis in infants[J].Journal of Clinical Pediatric Surgery,2019,18(09):733-738.[doi:10.3969/j.issn.1671-6353.2019.09.005]
婴幼儿化脓性脑膜炎合并硬膜下积液及脑室炎的外科治疗效果评估
- Title:
- Efficacy evaluations of surgery for suppurative meningitis with subdural effusion and ventriculitis in infants
- Keywords:
- Purulent Meningitis; Subdural Effusion; Ventriculitis; Antibacterial Therapy; Surgical Procedures; Operative
- 分类号:
- R726;R512.3
- 摘要:
- 目的 初步探索外科治疗婴幼儿化脓性脑膜炎合并硬膜下积液、积脓及脑室炎等合并症的有效性和安全性。方法 按照治疗方式的不同将所有入选的受试者分为外科手术组及保守治疗组。外科手术组为深圳市儿童医院2009年7月至2018年3月收治的33例化脓性脑膜炎合并硬膜下积液、脑室炎病例，其中硬膜下积液29例，脑室炎4例，均经腰椎穿刺、头颅增强MR确诊。在全身使用足量敏感抗生素不能有效控制感染的情况下，分别给予硬膜下积液钻孔引流、经前囟穿刺、侧脑室外引流、开颅脓腔清除+外引流、脑室镜下脑室内分隔开窗术等外科处理。保守治疗组为深圳市儿童医院2005年1月至2009年7月收治的确诊为化脓性脑膜炎合并上述并发症的25例患儿，其中硬膜下积液23例，脑室炎2例，均给予内科保守治疗。采用SPSS 18.0进行统计学分析。结果 经上述治疗后，外科手术组治愈28例，治愈率为84.8%，好转5例；中位住院时间27 d。保守治疗组治愈7例，治愈率为28%，好转13例，无效5例，其中3例死亡，中位住院时间44 d。经统计检验，两组间的治愈率、中位住院时间存在显著性差异（P<0.05）。结论 硬膜下积液及脑室炎均为婴幼儿化脓性脑膜炎的难治性并发症，单纯内科治疗效果不佳时，恰当选择外科治疗手段是提高临床疗效、减少抗生素使用和降低远期并发症发生率的有效手段。
- Abstract:
- Objective To explore the efficacy and safety of surgical treatment of septic complication of infantile suppurative meningitis with subdural effusion,empyema and ventriculitis.Methods All enrolled subjects were divided into surgical and conservative treatment groups according to different treatment methods.Among them,the surgical group was composed of 33 hospitalized cases of suppurative meningitis with subdural effusion and ventriculitis from July 2009 to March 2018.There were subdural effusion (n=29) and ventriculitis (n=4).All cases were definitely diagnosed by lumbar puncture and cranial enhanced magnetic resonance (MR).In case of systemic use of sufficient sensitive antibiotics failing to effectively control infection,subdural effusion drainage,anterior iliac puncture,lateral cerebral drainage,craniotomy,external drainage and ventricular fenestration were employed.The conservative treatment group had 25 children of suppurative meningitis complicated with subdural effusion (n=23) and ventriculitis (n=2) from January 2005 to July 2009 at Shenzhen Children’s Hospital.Conservative treatment of internal medicine was offered.Statistical analysis was performed using SPSS 18.0.Results After the above treatments,28 cases were cured in surgical group with a cure rate of 84.8%,5 cases improved,none was ineffective and the median hospital stay was 27 days.In conservative treatment group,7 cases were cured with a cure rate of 28%,13 cases improved and 5 cases were ineffective.Among them,there were 3 deaths and the median hospital stay was 44 days.According to statistical tests,significant inter-group differences existed in cure rate and median hospital stay (P<0.05).Conclusion Subdural effusion and ventriculitis are refractory complications of infantile purulent meningitis.When simple medical treatment is ineffective,proper surgery may be selected for improving clinical efficacy,minimizing antibiotic use and lowering the incidence of long-term complications.
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备注/Memo
收稿日期:2019-06-28。
通讯作者:陈乾,Email:chenqian68@126.com