腰大池引流术治疗未拔除脑室腹腔分流管的颅内感染七例报道及文献回顾

Use of lumbar drainage for treating intracranial infection caused by not removing shunts after ventriculoperitoneal shunt procedures and a systematic literature review

目的总结脑室腹腔分流术后颅内感染的临床特点和治疗效果。方法收集郑州大学人民医院神经外科自2013年1月至2016年1月行脑室腹腔分流术治疗脑积水患者．其中7例分流术后并发颅内感染患者及家属拒绝拔除分流装置。对颅内感染者在脑脊液细菌培养和药敏试验结果出来前，通过腰大池引流术持续引流感染的脑脊液；细菌培养和药敏试验结果出来后，选用敏感抗生素，必要时鞘内注射。结果3例患者6月后随访经腰大池引流术后及鞘内注射抗生素后治愈，1例拔除腰大池分流管后2月复查感染临床症状出现，2例住院期间拔除分流装置后再次植入分流装置，1例患者死亡。结论腰大池引流术在脑室腹腔分流术后感染非拔除分流装置时候是一种有效的手段，具有一定的临床价值。

Objective To summarize the clinical characteristics of and the treatment efficacy of intracranial infections after ventriculoperitoneal shunt procedures. Methods Among the hydrocephalus patients who were treated by ventriculoperitoneal shunt from January 2013 to January 2016, there were seven cases that had an intracranial infection, but the patients and their families refused to remove shunt devices. Before the cerebrospinal fluid bacterial culture and drug sensitivity test results were available for the intracranial infection patients, their cerebrospinal fluid was drained through continuous lumbar drainage. After the bacterial culture and drug sensitivity test results had come out, they were treated with the intrathecal injection of sensitive antibiotics when necessary. Results Three patients were cured after lumbar drainage and intrathecal injection of antibiotics, showed by the follow-up six months later. One patient exhibited clinical symptoms of infection in a follow-up recheck two months later after removal of the lumbar shunt. Two patients implanted shunt devices again after the removal of the shunt devices during hospitalization. One patient died. Conclusion The lumbar drainage is an effective measure with clinical values for infections caused by not removing shunts after ventriculoperitoneal shunt procedures.