婴幼儿硬膜下积液的外科治疗

目的 评价硬膜下积液—腹腔分流术(内引流术)和持续外引流术对治疗各种原因引起的顽固性硬膜下积液的疗效。方法 57例硬膜下积液患儿包括外伤性24例、化脓性脑膜炎2l例、原发性ll例、Sturge-Weber征l例。根据积液性质，25例行外引流术，其中5例积液增多改内引流术；32例直接行内引流术。结果 25例外引流患儿中20例CT征象和临床症状好转，5例改行内引流其中4例好转，l例症状无改善，CT显示脑萎缩；32例直接行内引流者，l例出现转流管阻塞经再通术后好转，余患儿临床症状好转，共计26例治愈予拔管。内引流治愈率70％，总有效率97％。结论 内引流术手术创伤小，疗效满意，对非感染性和非血性硬膜下积液，可作为首选方法，对有内引流术指征患儿则行外引流术。     

小儿外伤性硬膜下积液127例临床分析

目的 总结小儿外伤性硬膜下积液的病因、临床特征、诊断与治疗.方法 回顾性分析127例小儿外伤性硬膜下积液的临床特点、影像学资料和不同时期的治疗方法.结果 保守治疗后,86例在2周～3个月内积液完全消失,41例手术患儿1个月内积液减少,6个月内积液消失.结论 小儿外伤性硬膜下积液的诊断以临床表现和影像学资料为主,只要早期诊断、合理治疗,大部分保守治疗后恢复良好;对积液量多、症状明显者应及时手术引流,减少后遗症,提高疗效.     

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

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。     

双腔引流管引流治疗小儿慢性硬膜下血肿

慢性硬膜下血肿 (CSDH) ,指血肿存留2～3周以上 ,其表面有包膜形成 ,在小儿颅脑损伤中比较常见。我院自1997年3月至2001年11月共对28例小儿CSDH采用钻孔双腔引流管引流 ,效果显著 ,并发症少 ,现报告如下。临床资料男18例 ,女10例 ;年龄1岁5个月～9岁 ,平均6.2岁 ;病程最短16d ,最长3月。其中摔伤18例 ,不明原因2例 ,其他8例。血肿部位位于右侧12例 ,左侧11例 ,双侧5例。头痛、呕吐20例 ,嗜睡、精神不振6例 ,抽搐12例 ,视乳头水肿16例。所有28例患儿均经CT检查 ,中线结构移位20例 ,脑室受压变形18例。按照多田氏方程式计算血肿量(π6×长…     

高压氧对小儿难治性硬膜下积液术后脑复张疗效分析北大核心CSCD

目的探讨高压氧治疗对小儿难治性硬膜下积液行钻孔引流手术后脑复张的影响。方法我科收治的6O例因化脓性脑膜炎并发硬膜下积液患儿根据硬膜下积液厚度采取分层区组随机分为2组。治疗组3（）例在术后常规药物治疗的基础上行高压氧治疗,对照组3O例术后常规药物治疗。根据复查头颅CT硬膜下残腔最大层面的厚度（T）,将脑复张的程度分为4级（I级：T〈0．5cm,Ⅱ级：0．5cm≤T〈1cm,Ⅲ级：1cm≤T〈1．5cm,Ⅳ级：T≥1．5cm）。分别比较两组术后1、3、6个月时患儿脑复张程度。结果术后1个月,治疗组复查头颅CT统计硬膜下残腔厚度为（O．6±0．2）cm,脑复张程度l级（8例）,Ⅱ级（22例）;对照组为（0．7±0．2）cm,脑复张程度I级（5例）,Ⅱ级（25例）;两组比较,差异无统计学意义（P〉0．05）。术后3个月时,治疗组复查头颅CT硬膜下残腔为（（）．4±0．1）cm,恼复张程度I级（20例）,Ⅱ级（10例）;对照组为（0．6±0．2）cm,脑复张程度I级（9例）,Ⅱ级（21例）;两组比较,差异有统计学意义（P〈0．05）。术后6个月时,治疗组复查头颅CT硬膜下残腔为（0．2±0．1）cm,脑复张程度I级（30例）,Ⅱ级无;对照组为（0．5±0．1）cm,脑复张程度I级（18例）,Ⅱ级（12例）;两组比较,差异有统计学意义（P〈0．05）。结论高压氧能有效促进难治性硬膜下积液术后脑复张,可作为难治性硬膜下积液术后常规辅助治疗措施。     

化脓性脑膜炎合并硬膜下积液80例分析

目的 探讨更合理的化脓性脑膜炎合并硬膜下积液的诊断与治疗方法。方法 收集1992年1月至1999年12月确认为化脓性脑膜炎的病例291例，男188例，女103例，年龄10d至13岁。结果 291例化脓性脑膜炎中并发硬膜下积液者80例，发病率为27．5％，年龄在15d－16个月，均为前囟门未闭的儿童。在并发硬膜下积液的80例中以肺炎双球菌脑膜炎为多，占37例（46．3％），其次为嗜血流感杆菌脑膜炎，21例（26．3％）。不同细菌脑膜炎硬膜下积液的发生率不同。硬膜下积液多出现在病程的4－10d。80例合并硬膜下积液的病人中，单纯性积液7例；硬膜下感染45例；积脓28例，2例死亡。结论 硬膜下积液、感染或积脓的病因尚不明确，可能与化脓性脑膜炎时，脑血管通透性增强，脑血管表浅静脉发生炎性栓塞，细菌随血液循环进入硬膜下腔等因素有关。诊断明确者经过积极合理的治疗，成活者，积液均于6个月内吸收。     

小儿外伤性硬脑膜下积液的手术治疗

目的：探讨小儿外伤性硬膜脑下积液的外科治疗，同时介绍一种蛛网膜造瘘和颞肌堵塞的手术治疗方法。方法：12例外伤性硬膜脑下积液患儿中3例给予单纯钻孔引流术，3例在接受多次单孔引流术后因复发而接受蛛网膜造瘘颞骨堵塞手术，另6例患儿直接给予蛛网膜造瘘及颞肌堵塞手术治疗；蛛网膜造瘘及颞肌堵塞治疗的方法为：在基础及局麻下，于患侧颞部做4cm长深达骨膜的皮肤直切口牵开，颅骨钻孔一枚后扩大成直径为3cm的骨窗，电烙切开骨下的硬脑膜，缓慢放出硬脑下积液；在蛛网膜上做一小的撕裂口；制取术野2cm宽的带蒂颞肌瓣，做适当的剪裁延长并严密止血后，将其游离段经骨孔置入硬脑膜下腔并在骨窗处适当固定。结果：3例患儿在单纯钻孔引流术后一次治愈；3例经多次钻孔引流失败者及另6例患儿均在一次性蛛网膜造瘘及颞肌堵塞手术后治愈。结论：蛛网膜造瘘及颞肌堵塞术是一种治疗外伤性硬膜脑下积液的实用方法，其操作简单，并发症少，效果理想。     

新生儿缺氧缺血性脑病致硬膜下积液7例报告

新生儿缺氧缺血性脑病(HIE)是新生儿期常见的缺氧性脑症,病死率较高,存活者常留下各种神经系统后遗症,而引起硬膜下积液者尚未见报道,现将6年来收治的7例报告如下。6年来本科共收治新生儿HIE397例。临床资料本组病例中男5例,女2例。出生时均因新生儿HIE住本科治愈出院。当时7例均作CT检查未发现硬膜下积液。新生儿HIE的诊断按照1990年济南会议制定的标准,分度参照韩玉昆等新生儿HIE分度法,其中轻度6例,中度1例。7例均为足月儿。5例病人为双侧额、颞、顶、枕部硬膜下积液,另2例为双侧额、顶、颞部硬膜下积液。其中5例于年龄3个月左右…     

细菌性脑膜炎并硬膜下积液的相关因素

目的 探讨细菌性脑膜炎并硬膜下积液的因素,减少、预防硬膜下积液的发生.方法 收集在本院住院的细菌性脑膜炎患儿88例,入院后予抗感染、脱水降颅压、退热、止惊等处理,完成影像学检查及腰椎穿刺术,检测血生化、脑脊液等.观察并追踪随访到患儿出院后0.5a,按是否并硬膜下积液分为硬膜下积液组及对照组.定期收集2组患儿相关检查和临床资料,应用相关分析等统计学方法探讨硬膜下积液发生的相关因素.结果 二组间CRP(t =2.469,P=0.016)、降钙素原(PCT)(t=2.172,P=0.034)及脑脊液蛋白(t =2.729,P=0.008)差异均有统计学意义.简单相关分析发现脑脊液蛋白与病程(r=0.642,P =0.045)、ESR(r=0.737,P=0.037)中度相关,脑脊液蛋白与CRP(r=0.924,P=0.008)、PCT(r=0.912,P=0.024)高度相关,脑脊液糖与脑脊液蛋白呈负相关(r=-0.655,P=0.040).等级相关分析发现CRP(Kendall's相关系数为0.707,P=0.020;Spearman's相关系数为0.822,P =0.007)、PCT( Kendall’s相关系数为0.687,P=0.040;Spearman's相关系数为0.762,P=0.031)、脑脊液蛋白(Kendall's相关系数为0.699,P=0.019;Spearman's相关系数为0.782,P=0.007)与硬膜下积液中度相关,ESR(Kendall's相关系数为0.442,P=0.032;Spearman's相关系数为0.514,P=0.023)与硬膜下积液低度相关.脑脊液糖、氯化物等与硬膜下积液无相关性(Pa＞0.05).结论 细菌性脑膜炎并硬膜下积液具有更高的炎性反应,临床上需注意减轻炎性反应、减少渗出以预防硬膜下积液.     

Ommaya囊置入外引流术在幼儿化脓性脑膜炎合并硬膜下积液治疗中的应用

目的探讨应用Ommaya囊置入外引流术治疗幼儿化脓性脑膜炎合并硬膜下积液的临床效果。方法2010年6月至2013年6月我们对38例化脓性脑膜炎合并硬膜下积液患儿,在抗感染治疗的同时,置入Ommaya囊持续外引流,观察临床症状的改善程度,并行头颅CT检查硬膜下积液吸收情况。结果28例患儿经持续引流5～7d后,发热、头痛及呕吐症状均明显减轻,又反复穿刺囊体3～6次并引流,2个月后复查头颅CT,提示29例硬膜下积液明显减少,9例无变化;术后1年复查,32例硬膜下积液消失,3例明显减少,3例因脑膜炎控制效果差,症状反复,放弃治疗。结论Ommaya囊可以长期置入,反复穿刺引流,较传统颅骨钻孔直接外引流,减少了感染风险,是治疗幼儿化脓性脑膜炎合并硬膜下积液的一种有效方法。     

Ӥ�׶���ŧ����Ĥ�׺ϲ�ӲĤ�»�Һ��Σ�����ط���

??Objective??To investigate the risk factors of purulent meningitis complicated with subdural effusion in infants and young children. Methods??The clinical data of the infants and young children who were diagnosed with purulent meningitis in PICU of Shengjing Hospital of China Medical University from January 2014 to December 2017 were analyzed retrospectively. All of them were divided into 2 groups according to whether there was complication of subdural effusion. The statistical data were analyzed by SPSS 20.0 software. Results??There were significant differences in hemoglobin??C reactive protein and protein in cerebrospinal fluid between control group and subdural effusion group??P??0.05??. Logistic regression analysis showed that hemoglobin??OR??0.940??95%CI??0.899—0.998????C reactive protein??OR??1.015??95%CI??1.004—1.028?? and protein in cerebrospinal fluid??OR??2.490??95%CI??1.151—6.315?? were independent risk factors for purulent meningitis complicated with subdural effusion??P??0.05??. Conclusion??Infants and young children diagnosed with purulent meningitis are with lower hemoglobin. Higher C reactive protein and higher protein in cerebrospinal fluid are likely to be complicated with subdural effusion.     

Clinical spectrum of tuberculous pleural effusion in children

BACKGROUND: The aim of this study was to describe the clinical characteristics and potentially diagnostic specimens of pediatric patients with tuberculous pleural effusion (TPE) to make a prompt diagnosis. METHODS: Children who had TPE from September 1997 to December 2003 were retrospectively reviewed at a tertiary pediatric facility in northern Taiwan. RESULTS: There were seven boys and six girls and their ages ranged from 10 to 17 years (average, 14.6 years). Tuberculosis contact history was identified in only six patients (46%). Fever (12/92%), cough (9/69%) and malaise (6/46%) were the most common symptoms. Normal leukocyte count was found in 12 patients (92%). Chest radiograph review showed unilateral pleural effusion in 12 patients (92%) but parenchymal involvement was found in nine patients (69%). Most of the pleural fluid analysis showed a lymphocytic exudative effusion (5/6). The acid-fast bacilli (AFB) stain of sputum, gastric washing, and pleural aspirate was positive in six of 11 (55%), two of seven (29%), and one of five (20%) patients, respectively. Culture of sputum, gastric washing, and pleural aspirate yielded Mycobacterium tuberculosis in four of 11 (36%), two of seven (29%), and two of five (40%) patients, respectively. A total of 6 to 9 months of multiple-drug therapy for tuberculosis was successful without sequale. CONCLUSIONS: Tuberculous pleural effusion usually presents as an acute illness and should always be considered in the differential diagnosis for older children and adolescents with pneumonia. A normal leukocyte count with a lymphocytic exudative effusion may provide a clue to the correct diagnosis of TPE. Diagnostic specimen of sputum seems more effective and sensitive in childhood TPE, especially those having pulmonary involvement.     

Successful treatment with linezolid of meningitis complicated with subdural empyema in a 6-month-old boy

Recent findings have focused on the possible role of linezolid as a suitable candidate for the treatment of central nervous system infections. The linezolid treatment for meningitis was sporadically reported in adults but there was no report in children. Here, we present a 6-month-old boy with meningitis and subdural empyema which was unresponsive to more conventional agents but successfully treated with linezolid therapy. A previously healthy 6-month-old boy was referred to our clinic for deteriorating general condition with fever, vomiting and seizures. He had fever and tense-bulging anterior fontanelle. Based on his first cerebrospinal fluid (CSF) results, empirical antibiotic therapy for bacterial meningitis consisting of vancomycin and ceftriaxone was started. However, CSF culture yielded no micro-organisms but blood culture showed coagulase-negative Staphylococci. On the 7th day, he still had high fever and the erythrocyte sedimentation rate (ESR) and serum CRP levels had risen by 105 mm/h and 36.2 mg/dl, respectively. On 10th day, computerized cranial tomography showed bilateral frontoparietal subdural empyema. Purulent material was evacuated by burr hole, and gram stains of the material showed polymorphonuclear leukocytes and no microorganisms. Clinical and CSF findings of our case were, unresponsiveness to vancomycin, ceftriaxone and consecutive meropenem treatment while we still observed subdural empyema during these treatments. For this reason we started linezolid 10 mg/kg twice daily. Clinical signs improved dramatically, with both completely normal neurological findings and normalization of CSF and radiological findings. To the of our best knowledge, linezolid treatment of meningitis in children has not been reported previously. Clinical and CSF findings of our case were improved completely with linezolid treatment. Also, control cranial computerized tomography showed the total recovery of subdural empyema. Here we present the youngest case with meningitis which was successfully treated with linezolid treatment.     

Surgical treatment outcomes in subdural effusion: a clinical study

OBJECTIVE: In this study, patients who underwent surgery due to subdural effusion were retrospectively analyzed. The location, depth and etiology of the subdural effusion, the surgical approach that was used and the recurrence rates were studied in these patients. METHOD: A total of 32 patients who were followed up and treated for subdural effusion at the Neurosurgery Clinic of the Yüzüncü Yil University School of Medicine were included in the study; 18 (56%) of the patients were male and 14 (44%) were female. The surgical techniques applied were surgical burr hole drainage, repeated subdural transaxial puncture and subduroperitoneal shunt approaches. The patients were evaluated by computerized tomography of the brain in week 1 and in the third month after surgery. Recurrences were evaluated based on radiological findings and the clinical condition of the patients. RESULT: The consciousness level of the patients was proportional to the mass effect of the subdural effusion. Lower recurrence rates were found in patients with a large midline shift resulting from the subdural effusion. In addition, recurrence rates were higher in patients with cerebral atrophy and lower protein content in the subdural effusion fluid. It was observed that these patients responded better to the subduroperitoneal shunt treatment.     

儿童感染性胸腔积液的治疗进展

儿童感染性胸腔积液指任何感染引起的胸腔积液,其常见病原体包括细菌、支原体以及结核。儿童感染性胸腔积液的治疗包括一般治疗、相关抗感染药物(包括抗生素或者抗结核药物)、胸腔穿刺或者引流、联合使用纤溶激活物、电子胸腔镜以及开胸手术(胸膜纤维板剥脱术、改良胸廓成形术、胸膜肺切除术)等。该文综合近年来相关文献,对以上治疗方法的适应证、疗效以及预后作一综述。     

儿童复杂性肺炎旁胸腔积液危险因素分析

目的探讨儿童复杂性肺炎旁胸腔积液(CPPE)发生的相关危险因素。方法回顾性分析2013年1月至2015年4月因肺炎旁胸腔积液住院的88例患儿的临床资料,根据应用抗生素治疗是否有效及相关文献分为复杂性肺炎旁胸腔积液组(CPPE组)及非复杂性肺炎旁胸腔积液(UPPE)组;对两组患儿的临床和实验室指标进行组间单因素分析,并进一步行多因素logistic回归分析,绘制受试者工作特征(ROC)曲线。结果单因素分析结果显示,两组患儿在纤维分隔形成及血清CD3~+、CD19~+水平的差异有统计学意义(Z=2.030~7.457,P均0.05);多因素logistic回归分析显示,纤维分隔形成及CD19~+为CPPE发生的独立危险因素(OR=3.386~4.000,P0.05);logistic回归模型的ROC曲线下面积(AUC)=0.707,具有中等诊断准确度(P=0.001)。结论伴有纤维分隔形成及血清CD19~+含量30%的PPE患儿发展为CPPE的可能性大。     

��������ǻ��Һ��ϼ�����

??The pathogenesis of tuberculous pleural effusion??TPE?? is mainly due to pleural delayed hypersensitivity to mycobacterial protein. The diagnosis of TPE is largely based on age??clinical manifestations??chest imaging features??a history of contact with tuberculosis??tuberculin skin test??pleural fluid analysis and microbiology. The treatment of TPE is mainly through the use of antituberculous drugs. Therapeutic thoracentesis should be used and corticosteroids can be added for massive tuberculous pleural effusion.