64例神经外科脑脓肿老年患者临床特点及手术治疗效果

Clinical characteristics and surgical treatment efficacy of 64 elderly patients with brain abscess in neurosurgery department

目的探讨脑脓肿老年患者的临床特点及治疗方式。方法收集某院2008年1月-2016年12月神经外科收治的经手术治疗脑脓肿老年患者的临床资料,分析其临床特点、治疗方式及预后。结果共收治经手术治疗的脑脓肿老年患者64例,其中发热14例(21.9%),有明确感染病史者9例(14.1%),脑膜刺激征6例(9.4%),实验室检查提示可能感染11例(17.2%)。患者起病至就诊时间平均(43.3±20.4)d。影像学表现为囊性(17例)、囊实性(38例)或实性(9例)病变。在增强扫描下显示病变无明显包膜者9例,薄壁者(<2 mm)11例,厚壁者(>2 mm)44例;病变包膜环形强化,或病变不均匀强化。行脓肿切除术48例,脓肿穿刺治疗16例。术后2周疗效GOS评分,1分(死亡)4例,2~3分11例,4~5分49例。除死亡4例和失访6例,其余54例患者平均随访(25.7±16.4)个月,GOS 1分2例,2~3分1例,GOS 4~5分51例。结论脑脓肿老年患者缺乏全身感染症状,颅内压增高的临床症状不明显,发病至首次就诊时间较长,影像学表现多为典型厚壁囊实性占位伴环形强化的脑脓肿征象,在治疗上应遵循个体化治疗原则,可获得良好的预后。

Objective To investigate the clinical characteristics and treatment of brain abscess in elderly patients.Methods Clinical data of elderly patients with brain abscess treated in neurosurgery department in a hospital from January 2008 to December 2016 were collected,clinical characteristics,treatment methods and prognosis were analyzed.Results A total of 64 elderly patients who underwent operation for brain abscess,including 14 cases(21.9%)with fever,9 cases(14.1%)with a definite history of infection,6 cases(9.4%)with meningeal irritation sign,laboratory examination indicated that 11 cases(17.2%)might be infected.The average time from onset to consultation was(43.3±20.4)days.Imaging findings were lesions of cystic(17 cases),cystic-solid(38 cases)or solid(9 cases).Enhanced scan showed no obvious envelope in 9 cases,thin wall(<2 mm)in 11 cases,and thick wall(>2 mm)in 44 cases;lesion envelope showed circular enhancement or inhomogeneous enhancement.48 cases underwent abscess resection and 16 cases underwent abscess puncture.Two weeks after operation,the Glasgow outcome scale(GOS)was 1 point(death)in4 cases,2-3 points in11 cases and4-5 points in49 cases.Except for4 cases of death and 6 cases of loss to follow-up,the other 54 patients were followed up for an average of(25.7±16.4)months,GOS were 1 point in2 cases,2-3 points in1 case,and4-5 points in51 cases.Conclusion Elderly patients with brain abscess lack symptoms of systemic infection,clinical symptoms of intracranial hypertension are not obvious,interval between onset and first consultation is long,imaging manifestations show brain abscess with typical thick-walled cystic-solid mass and circular enhancement,individualized treatment principle should be followed,and good prognosis can be obtained.