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多发性脑脓肿的综合性治疗(附5例分析)
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. DOI: 10.13798/j.issn.1009-153X.2021.11.005
作者姓名:韦 可 曹 杰 陈大瑜等
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)
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。

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
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. DOI: 10.13798/j.issn.1009-153X.2021.11.005
Authors:WEI Ke  CAO Jie  CHEN Da-yu  et al
Affiliation:Department of Neurosurgery, General Hospital of Central Theater Command, PLA, Wuhan 430070, China
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.
Keywords:Multiple brain abscesses   Stereotactic puncture drainage   High-throughput sequencing technique   Antibiotics
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