CAJ | 학술논문

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.
목적 탐토연성신경내경하뇌실관세치료뇌실감염적효과.방법 자2007년2월지2009년11월,응용전자연성신경내경대60례뇌실감염환자행뇌실관세치료.결과 일차성내경하뇌실관세치유뇌실감염병성공거제뇌실외인류혹분류26례,점43%;내경하뇌실관세후계속뇌실외인류병뇌실내응용항생소34례,점57%;뇌실외인류시간위4-76 d,평균20.1 d.기중거제뇌실외인류후잉유로내압증고수재차뇌실-복강분류자7례,점12%;사망5례,균위엄범내약적록농간균화진균감염,사망솔8%.결론 뇌실감염시신경외과림상중적일개극수문제,연성신경내경하뇌실관세치료뇌실감염가제고치료효과.
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.