| 多发性脑脓肿的综合性治疗（附5例分析） |
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| 引用本文： | 韦,可,曹,杰,陈大瑜等.多发性脑脓肿的综合性治疗（附5例分析）[J].中国临床神经外科杂志,2021,26(11):833-834. |
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| 作者姓名： | 韦 可 曹 杰 陈大瑜等 |
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| 作者单位： | 430070 武汉，中国人民解放军中部战区总医院神经外科（韦 可、、陈大瑜、杜 威、管江衡、姚国杰）；441003 湖北襄阳，中国人民解放军联勤保障部队第九九一医院神经外科（曹 杰） |
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| 摘 要： | 目的 探讨立体定向穿刺引流术联合抗生素综合性治疗多发脑脓肿的效果。方法 回顾性分析2018年4月至2020年10月收治的5例多发性脑脓肿的临床资料。急性脑炎期应给予广谱、足量抗感染治疗；脓肿包膜形成时，采取立体定向穿刺引流术，术后采用高通量测序技术检测病原菌，并根据结果调整抗生素。结果 5例中，3例进行两次引流术，2例进行单次引流术。术后高通量测序技术明确致病菌，经充足疗程的抗感染治疗，脓肿灶逐步消失，未发生脑疝，全部治愈出院。术后6个月随访，除1例遗留肢体轻瘫外，其余4例无肢体活动障碍。结论 对于多发性脑脓肿，尽早明确诊断、选择合理的治疗方式是提高脑脓肿治疗效果的关键；高通量测序技术为抗生素调整提供依据，并对感染源治疗有指导作用；立体定向穿刺引流术可以缩短疗程，减少抗生素应用时间，提高治疗效果。
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| 关 键 词： | 多发性脑脓肿 高通量测序技术 立体定向穿刺引流术 抗生素 |
Clinical efficacy of stereotactic puncture and drainage combined with antibiotics treatment for multiple brain abscesses: report of 5 cases and literature review |
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| WEI Ke,CAO Jie,CHEN Da-yu,et al.Clinical efficacy of stereotactic puncture and drainage combined with antibiotics treatment for multiple brain abscesses: report of 5 cases and literature review[J].Chinese Journal of Clinical Neurosurgery,2021,26(11):833-834. |
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| Authors: | WEI Ke CAO Jie CHEN Da-yu |
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| Affiliation: | Department of Neurosurgery, General Hospital of Central Theater Command, PLA, Wuhan 430070, China |
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| Abstract: | Objective To explore the clinical efficacy of stereotactic puncture and drainage combined with antibiotics treatment for the patients with multiple brain abscesses (MBA). Methods The clinical data of 5 patients with MBA who received stereotactic puncture and drainage combined with antibiotics treatment from April 2018 to October 2020 were retrospectively analyzed. In the acute encephalitis stage, a broad-spectrum and sufficient-time anti-infective treatment was administered on all the patients. After the abscess capsule formation, stereotactic puncture and drainage was performed on all the patients, and the high-throughput sequencing technique was used to detect pathogens and antibiotics were adjusted according to the sequencing results. Results Of these 5 patients, 3 patients underwent two drainages and 2 underwent single drainage. Postoperative high-throughput sequencing technique identified the pathogenic bacteria in all the patients. After a sufficient time of anti-infective treatment, the abscess gradually disappeared, and no brain herniation occurred. All the patients were cured. The follow-up (6 months) showed that 4 patients had no limb dysfunction and 1 had mild hemiplegia. Conclusions For the patients with MBA, early diagnosis and selection of appropriate treatment methods are the keys to improve the treatment effectiveness of brain abscesses. High-throughput sequencing technique provides an evidence for antibiotic adjustment and a guidance for the treatment of infection sources. Stereotactic puncture and drainage can shorten the course of treatment, reduce the application time of antibiotics, and improve the treatment effectiveness. |
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| Keywords: | Multiple brain abscesses Stereotactic puncture drainage High-throughput sequencing technique Antibiotics |
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