先天性皮肤窦道合并中枢神经系统感染的手术时机探讨

Discussion of surgical timing of congenital dermal sinus complicated with infection of the central nervous system

目的 探讨先天性皮肤窦道合并中枢神经系统感染手术切除病灶的时机.方法 回顾性分析2005年10月至2015年12月上海交通大学医学院附属上海儿童医学中心神经外科收治的先天性皮肤窦道合并中枢神经系统感染且处于活跃期的10例患儿的临床资料.其中5例患儿术前适当应用抗生素,待感染有所好转后立即手术;另5例感染未控制即行手术治疗.结果 10例患儿术后均有效控制感染,病灶无复发.相比感染未控制即行手术的5例患儿,感染初步控制后手术的5例患儿的手术用时平均减少了（1.3±0.3）h;打开椎体节段的数量少于感染未控制组;术后神经系统功能恢复满意,但患儿的平均住院时间较感染未控制组长[分别为（56.0±4.5）d、（40.0±7.7）d].结论 术前适量应用抗生素,感染初步控制后立即行手术可降低手术难度,减少手术创伤,有利于神经功能恢复,但增加了住院天数与治疗费用.

Objective To study the timing of surgical resection of congenital dermal sinus complicated with the infection of central nervous system.Methods We retrospectively analyzed 10 cases of congenital dermal sinus complicated with the infection of central nervous system admitted to Department of Neurosurgery,Shanghai Children＇s Medical Center between October 2005 to December 2015.Among them,5 cases had appropriate antibiotic administration prior to operation and underwent surgery immediately after infection was controlled.The other 5 cases received surgical treatment when the infection was not controlled.Results Among the 10 cases,infection was effectively controlled and no recurrence was observed.Compared with that in patients with uncontrolled infection,the average operative time was reduced by 1.3 ± 0.3 hours in 5 cases who had the operation after the infection was preliminarily controlled.The number of opened vertebral segments was less and the recovery of neurological function was better in patients with controlled infection.The average length of hospitalization was 16 days longer in infection-controlled than infection-uncontrolled patients.Conclusion Appropriate antibiotic administration prior to operation and immediate surgery following controlled infection could reduce operative difficulty and surgical trauma and facilitate recovery of neurological function.However,it might increase length of hospitalization and treatment costs.