脑脓肿不同时期手术干预的疗效分析

Analysis of curative effects of surgical interventions in different formation periods on brain abscess

目的 探讨脑脓肿不同时期手术方法及其疗效。方法 回顾性分析2010年1月-2015年12月收治的52例脑脓肿的临床资料，依据病理分期及手术方式分为4组：化脓期引流术组14例，化脓期切除术组13例，脓肿形成期引流术组10例，脓肿形成期切除术组15例。术后随访60 d，分析各组疗效、病死率、复发率及术后住院天数、神经症状缓解时间。结果 4组性别比、年龄分布、入院GCS评分无明显差异（P〉0.05）。脓肿形成期切除术组中位住院天数较脓肿形成期引流术组明显延长（P〈0.05），而与化脓期引流术组、化脓期切除术组均无明显差异（P〉0.05）。化脓期引流术组病死率明显高于其他3组（P〈0.05）。4组术后复发率均无明显差异（P〉0.05）。脓肿形成期切除术组中位神经症状缓解时间最短（P〈0.05）。结论 脓肿形成期引流术后住院天数较长，但神经症状缓解较快；化脓期出现脑疝征象时，应积极手术干预，必要时行去骨瓣减压术。

Objective To explore the effects of different surgical intervention in different period on brain abscess. Methods The clinical data of 54 patients with brain abscess treated in our hospital from January, 2010 to December, 2015 were analyzed retrospectively. According to the pathological stage and operation method, 54 patients were divided into four groups. Of 27 patients in maturating period, 14 underwent drainage of the abscess （group A） and 13 excision of the abscess （group B）. Of 25 patients in the maturated period, 7 underwent drainage of the abscess （group C） and 18 excision （group D）. The curative effect and postoperative hospital stays were compared among all the groups. Results There were insignificant differences in the male vs female ratio, ages and GCS score on admission to hospital among all the groups （P〉0.05）. The median hospital stays after the operation were significantly shorter in group D than group C （P〈0.05）. Three patients （20.0%, 3/15） died in group D. No patients died in the other groups. The death rate was significantly higher in group D than those in the other groups （P〈0.05）. Conclusions The curative effects of different surgery interventions in different periods of brain abscess formation on brain abscess are different from each other.