内镜神经外科技术结合脑室灌洗治疗化脓性脑室炎的疗效分析

Endoscopic neurosurgery combined with intraventricular lavage for pyogenic ventriculitis

目的探讨应用内镜神经外科技术结合脑室内抗生素盐水灌洗治疗化脓性脑室炎的疗效。方法回顾分析2001至2017年北京世纪坛医院、北京协和医院等6家医院诊治的45例化脓性脑室炎患者。2001至2009年采用脑室置管外引流结合脑室内抗生素用药治疗化脓性脑室炎24例（非内镜组），2010至2017年采用内镜神经外科技术结合脑室内抗生素盐水灌洗治疗化脓性脑室炎21例（内镜组）。比较内镜组和非内镜组脑室外引流管留置时间、患者住院时间、死亡率以及6个月后改良Rankin评分（mRS）。结果（1）脑室外引流管留置时间：内镜组（20±6）d，非内镜组（42±10）d，P〈0．001；（2）住院时间：内镜组（29±7）d，非内镜组（51±11）d，P〈0．001；（3）死亡情况：非内镜组8例（33．3％）死亡，内镜组仅1例（4．76％）死亡，P=0．017；（4）随访情况：治疗6个月后疗效满意（mRS≤3）率，内镜组66．67％，非内镜组为29．17％，P=0．001。结论内镜神经外科技术结合脑室内抗生素盐水灌洗能够有效诊疗化脓性脑室炎，值得进一步推广应用。

Objective To investigate the efficacy of endoscopic neurosurgery combined with intraventricular lavage for pyogenic ventriculitis. Methods A retrospective analysis of 45 patients with pyogenic ventriculitis in six hospitals which included Beijing Shijitan Hospital and Peking Union Medical College Hospital from 2001 to 2017. Twenty-four patients （non-endoscopic group） were treated with external ventricular drainage combined with intraventricular antibiotics administration from 2001 to 2009. Twenty-one patients （endoscopic group ） was treated by endoscopic neurosurgery combined with intraventrieular antibiotics lavage from 2010 to 2017. The drainage time, mortality, and modified Rankin score （mRS） after 6 months of follow-up were compared between the two groups. Results Drainage time ： （20 ± 6 ） days in the endoscopic group, and （42 ± 10） days in the non-endoscopic group. There was a significant difference between the two groups （P 〈0. 001 ）. Days in hospital： （29 ±7） days in the endoscopic group, and （51 ± 11 ） days in the non-endoscopic group. There were significant differences between the two groups （P 〈 0. 001 ）. Mortality： 8 patients （33.3%） died in the non-endoscopy group, and 1 patient （4. 76% ） died in the endoscopy group. There was a significant difference between the two groups （P = 0. 017 ）. After 6 months of follow-up, patients of mRS≤3 were 14 cases （66. 67% ） in the endoscopy group, and 7 cases （29. 17% ） in the non-endoscopic group. There was a significant difference between the two groups （P = 0. 001 ）. Conclusion Endoscopic neurosurgery combined with intraventricular antibiotics saline lavage for pyogenic ventriculitis is an effective assessment and treatment method, and it is worth further promotion and application.