神经内镜经鼻颅底外科术后颅内感染的危险因素分析

Risk factors of intracranial infection after endoscopic transnasal skull base surgery

目的分析影响神经内镜经鼻颅底外科手术后发生颅内感染的危险因素,以期指导临床预防与治疗。方法回顾性分析2013年1月至2018年6月首都医科大学附属北京天坛医院神经外科行神经内镜经鼻颅底手术治疗的1467例患者的临床资料。术后根据患者是否发生颅内感染分为感染组(17例)和非感染组(1450例),采用单因素和多因素logistic回归分析方法分析影响神经内镜经鼻颅底手术治疗的患者发生颅内感染的危险因素。结果1467例患者经手术治疗后,17例(1.2%)发生颅内感染,其中7例为垂体腺瘤,6例为脊索瘤,2例为颅咽管瘤,1例为Rathke囊肿,1例为脑脊液鼻漏。17例患者的感染时间为术后2~12d,平均(5.0±2.5)d;其中1例<3d,13例3~7d,3例>7d。脑脊液培养结果:5例为草绿色溶血性链球菌,4例为肺炎克雷伯杆菌,2例为表皮葡萄球菌,2例为大肠埃希氏菌,2例为产气肠杆菌,1例为副溶血性链球菌,1例为枸橼酸杆菌。单因素和多因素logistic回归分析结果显示,术中脑脊液漏(OR=3.074,95%CI:2.084~4.536,P<0.01)、术后脑脊液漏(OR=27.780,95%CI:10.266~75.148,P<0.01)及腰大池引流(OR=192.150,95%CI:25.245~1462.465,P<0.01)是影响颅内感染发生的危险因素,而预防性使用抗生素(OR=0.204,95%CI:0.062~0.671,P<0.01)是其保护因素。结论避免术中脑脊液漏和腰大池引流、预防术后脑脊液漏及术前预防性使用抗生素是降低神经内镜经鼻颅底外科手术后颅内感染发生的重要手段。

Objective To analyze the risk factors of intracranial infection after endoscopic transnasal skull base surgery in order to guide clinical prevention and treatment. Methods The clinical data of 1 467 patients who underwent endoscopic transnasal skull base surgery from January 2013 to June 2018 at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University was retrospectively analyzed. Postoperative patients were divided into infection group (17 cases) and non-infection group (1 450 cases) according to whether they had intracranial infection or not. Univariate and multivariate logistic regression were used to analyze the risk factors of intracranial infection in patients undergoing endoscopic transnasal skull base surgery. Results After surgical treatment, 17 (1.2%) cases developed intracranial infection, including 7 pituitary adenomas, 6 chordomas, 2 craniopharyngiomas, 1 Rathke cleft cyst and 1 cerebrospinal fluid rhinorrhea. The duration of infection was 2-12 days after operation, with an average of 5.0 ± 2.5 days and it was less than 3 days in 1 case, 3-7 days in 13 and more than 7 days in 3. The results of cerebrospinal fluid culture showed that the bacteria were Streptococcus viridis in 5 cases, Klebsiella pneumoniae in 4, Staphylococcus epidermidis in 2, Escherichia coli in 2, Enterobacter aerogenes in 2, Streptococcus parahaemolyticus in 1 and Citrobacter in 1. Univariate and multivariate logistic regression analysis showed that intraoperative cerebrospinal fluid leakage (OR= 3.074, 95% CI: 2.084-4.536, P<0.01), postoperative cerebrospinal fluid leakage(OR = 27.780, 95% CI: 10.266-75.148, P<0.01)and lumbar cistern drainage (OR=192.150, 95% CI: 25.245-1 462.465, P<0.01) were risk factors for intracranial infection, while prophylactic use of antibiotics was the protective factor (OR=0.204, 95% CI: 0.062-0.671, P<0.01). Conclusion Avoiding intraoperative cerebrospinal fluid leakage and lumbar cistern drainage, preventing postoperative cerebrospinal fluid leakage and preoperative prophylactic use of antibiotics seem to be important means to reduce the incidence of intracranial infection after endoscopic transnasal skull base surgery.