硬膜下脓肿的诊断与治疗

Diagnosis and treatment of subdural abscess

目的探讨硬膜下脓肿的诊断与治疗的方法及预后。方法选取自2008年1月至2015年5月期间安庆市第一人民医院神经外科收治的4例硬膜下脓肿的临床资料、手术方式的选择及预后进行回顾性分析。3例患者入科室时已出现脑疝,急诊行去骨瓣减压术+硬膜下脓肿清除术,1例行硬膜下脓肿钻孔引流。结果 4例患者经积极救治后均恢复良好,治疗后按目前常用的日常生活能力分级(GOS评分):Ⅰ级(能独立活动,无需帮助或指导)3例;Ⅱ级(能活动,但须指导)1例。结论硬膜下脓肿在神经外科疾病中很少见,但由于硬膜下腔缺乏任何间隔的解剖特点,一旦发生硬膜下脓肿,脓肿的扩展范围广泛,后果严重。治疗除全身使用抗生素外,钻孔引流效果最好,引流管的通畅是提高治愈率的关键。

Objective To explore the treatment and prognosis of subdural abscess. Methods A retrospective analysis was made to clinical informations, surgical procedure selections and prognosis of 4 subdural abscess patients, admitted to the Anqing First People＇s Hospital from January 2008 to May 2015. 3 cases of them had cerebral hernia when they were admitted to the department, underwent emergency decompressive craniectomy and Removal of subdural abscess; 1 case underwent drainage of subdural abscess. Results 4 patients all recovered well after active treatment. According to common daily life ability classification （GOS）：grade I 3 cases （Independent activities, without help or guidance）;grade Ⅱ 1 cases （activity, must guide）. Conclusion Subdural abscess is a rare disease in the department of neurosurgery. Due to the lack of any interval between the subdural space, once the subdural abscess occurs and the range of abscess got bigger, the consequences will be very serious. In addition to systemic use of antibiotics, the effect of trepanation and drainage is the best. So keeping the drainage tube unobstructed is the key to improve the cure rate.