摘要
目的探讨软性神经内镜辅助下钻孔冲洗外引流术治疗婴幼儿化脓性脑膜炎合并硬膜下积液的临床效果。方法回顾性分析2016年1月至2020年12月重庆医科大学附属儿童医院神经外科收治的40例婴幼儿化脓性脑膜炎合并硬膜下积液的临床资料。按照治疗方式的不同,将40例患儿分为内镜组(采用软性神经内镜辅助下钻孔冲洗外引流术治疗,20例)和对照组(采用颅骨钻孔外引流术治疗,20例),比较两组的一般资料、临床表现、治疗相关指标和并发症情况。结果内镜组与对照组在性别、年龄、病程、临床表现、积液位置及术前脑脊液相关指标方面比较,差异均无统计学意义(均P>0.05)。内镜组术后症状改善时间、脑脊液改善(即脑脊液白细胞计数降至正常范围)时间均早于对照组[术后症状改善时间:(4.4±2.3)d对比(8.7±3.0)d;脑脊液改善时间:(6.3±3.5)d对比(13.2±5.2)d];术后抗感染治疗时间[M(Q1,Q3)]短于对照组[分别为11.5(8.3,14.0)d和19.0(14.0,27.3)d],差异均有统计学意义(均P<0.001)。术后并发症方面,对照组术后继发蛛网膜下腔出血及脑挫伤的发生率为25%(5/20),内镜组为0%(0/20)。结论对于化脓性脑膜炎合并硬膜下积液,与采用颅骨钻孔外引流术治疗相比,采用软性神经内镜辅助下钻孔冲洗外引流术治疗的患儿可在临床上获得更好的疗效,且并发症少。
Objective To investigate the clinical effect of flexible neuroendoscopy-assisted drilling irrigation and external drainage in the treatment of subdural effusion complicated with purulent meningitis in infants.Methods A retrospective analysis was conducted on the clinical data of 40 infants with purulent meningitis complicated with subdural effusion who were admitted to the Department of Neurosurgery,Children′s Hospital of Chongqing Medical University from January 2016 to December 2020.According to the different treatment methods,40 children were divided into an endoscopy group(treated by burr hole irrigation and external drainage assisted by flexible neuroendoscopy,20 cases)and a control group(treated by skull burr hole drainage,20 cases).The general data,clinical manifestations,treatment-related indicators and complications of the two groups were compared.Results There was no significant difference between the endoscopy group and the control group in gender,age,course of disease,clinical manifestations,location of effusion,or preoperative cerebrospinal fluid-related indicators(all P>0.05).The improvement time of symptoms and cerebrospinal fluid indicator(the white blood cell count in the cerebrospinal fluid returning to the normal range)in the endoscopy group were earlier than those in the control group(postoperative symptom improvement time:4.4±2.3 d vs.8.7±3.0 d;cerebrospinal fluid indicator improvement time:6.3±3.5 d vs.13.2±5.2 d).Postoperative anti-infective treatment time[M(Q1,Q3)]in the endoscopy group was shorter than that in the control group[11.5(8.3,14.0)d vs.19.0(14.0,27.3)d].All the differences above were statistically significant(P<0.001).In terms of postoperative complications,there were 5 cases(25%)of secondary subarachnoid hemorrhage and cerebral contusion in the control group,and 0 cases(0%)in the endoscopy group.Conclusion For purulent meningitis complicated with subdural effusion,infants treated with flexible neuroendoscopy-assisted burr hole irrigation and external drainage can achieve
作者
程杨
周建军
赵雪灵
陈小兵
梁平
翟瑄
李禄生
周渝冬
Cheng Yang;Zhou Jianjun;Zhao Xueling;Chen Xiaobing;Liang Ping;Zhai Xuan;Li Lusheng;Zhou Yudong(Department of Neurosurgery,Children′s Hospital of Chongqing Medical University,National Clinical Research Center for Child Health and Disorders,Ministry of Education Key Laboratory of Child Development and Disorders,Chongqing Key Laboratory of Pediatrics,Chongqing 400014,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2022年第6期580-585,共6页
Chinese Journal of Neurosurgery
基金
重庆市科卫联合医学科研项目(2021MSXM014)。
