脑脓肿的诊断和治疗(附20例报告)

Diagnosis and treatment of brain abscesses: A report of 20 cases

目的探讨脑脓肿的诊断和治疗.方法1996年1月～2004年6月20例脑脓肿均行CT检查,8例行MR检查中2例行磁共振波谱检查,应用头孢曲松联合甲硝唑治疗1～9周,平均3.7周.CT或B超引导下3例行脓肿切除术,5例行脓肿穿刺引流术.结果1例因脓肿破入脑室死亡,16例治愈(无后遗症),3例好转(残留肢体偏瘫).8例手术患者无一例死亡.合并有糖尿病、结核、HIV抗体阳性及肾移植8例中4例治愈,无相关疾病12例治愈;脓肿与脑室关系密切9例中有5例治愈,脓肿表浅11例均治愈.5例多发脓肿均治愈,15例单发脓肿有11例治愈.结论脑脓肿早期诊断、早期抗感染治疗大部可治愈,MR是早期明确诊断的重要方法,立体定向手术是较好的手术方式.

Objective To discuss the diagnosis and treatment of brain abscesses. Methods A total of 20 patients with brain abscesses from January 1996 to June 2004 were studied. All the patients received a CT scanning, and 8 patients were given an MRI examination （two of them underwent a magnetic resonance spectroscopy）. An administration of ceftriaxone in combination with metronidazole was given for 1 - 9 weeks （ mean, 3.7 weeks）. Surgery was conducted in 8 patients under the guidance of CT scanning or B - ultrasonography, including 3 cases of abscess resection and 5 cases of aspiration and drainage. Results One patient died of ventricle involvement, 16 patients were cured without after- effects, and 3 patients were improved but the hemiplegia was left behind. No surgery - related deaths were encountered in the 8 surgical cases. Among 8 patients who complicated with diabetes mellitus, tuberculosis, HIV infection, or kidney transplantation, 4 patients were cured; all the remaining 12 patients without co- morbidities were cured. Among 9 patients with lesions closely near the ventricle, 5 were cured, while the rest of 11 patients with superficial abscesses were all cured. All the 5 patients with multiple abscesses were cured, and 11 out of 15 patients with solitary lesion were cured. Conclusions Most brain abscesses can be cured by early diagnosis and early drug administration. The magnetic resonance is an important means for early diagnosis, and the stereotactic operation is a favorable surgical treatment.