多发性脑脓肿的综合性治疗（附5例分析）

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。

Clinical efficacy of stereotactic puncture and drainage combined with antibiotics treatment for multiple brain abscesses: report of 5 cases and literature review

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.