多发性和多房性脑脓肿的临床特点分析

Clinical characteristics of multiple and multilocular brain abscesses

目的探讨多发性脑脓肿和多房性脑脓肿的细菌学特征、诱发因素、感染途径、临床表现、治疗选择和预后等。方法回顾性分析1991-2010年收治的85例脑脓肿患者的临床资料,其中单发性脑脓肿52例,多发性脑脓肿15例,多房性脑脓肿18例。结果多发性脑脓肿和多房性脑脓肿占全部脑脓肿的比例分别为17.6%和21.2%。血行感染为常见的感染类型(分别为73.3%和50.0%);体温升高、头痛、恶心呕吐为最常见的症状;细菌培养阳性率高于单发脑脓肿且金黄色葡萄球菌为最常见致病菌;立体定向脓肿穿刺引流术为最常用的治疗方法;30.8%的多房性脑脓肿需重复治疗,而单发性脑脓肿为2.2%;3例多发性脑脓肿患者死亡,但均与治疗前病情危重或其他原因有关。结论多发性脑脓肿和多房性脑脓肿临床并不少见,其感染途径及临床表现与单发性脑脓肿有所不同,立体定向脓肿穿刺引流术仍是各种脑脓肿的首选治疗方法,但部分多房性脑脓肿需重复治疗。脑脓肿的预后与治疗前的病情严重程度有关。

Objective To determine whether there are differences in the bacteriology, predisposing factors, treatment option and outcome between single, multiple and multilocular pyogenic brain abscess. Methods We studied clinical data of 85 patients with pyogenic brain abscess collected during a 20-year period, including 52 cases of single, 15 multiple and 18 multilocular abscesses. Results The incidence of multiple and multilocular abscesses was 17.6% and 21.2%, respectively. Hematogenous spread from a remote infectious focus was the most common cause of infection for multiple （73.3%） and multilocular （50.0%） abscesses. Fever, headache, nausea and vomiting were the most common symptoms in patients with multiple and multilocular abscesses. Staphylococci aureus was the most commonly isolated pathogen in patients with multiple and multilocular abscess. Stereotactic aspiration of the abscess was performed for most of the patients, and the rate of re-operation was 2.2% for single, 2.7% for multiple and 30.8% for multilocular abscess, respectively. Mortality rate was 0.0% for single, 20.0% for multiple and 0.0% for multilocular abscess, respectively. Conclusions Multiple and multilocular pyogenic brain abscesses are not rare and their clinical characteristics are different from that of single abscess. Stereotactic operation is still the first treatment choice, but repeated aspiration maybe needed for some patients with multilocular abscess. Neurological status and seriousness of the illness before the operation were the most important factors influencing the prognosis.