脑室-腹壁皮下隧道长时程外引流治疗感染性脑积水的回顾性分析

Retrospective analysis on long-time external drainage through ventricular abdominal subcutaneous tunnel in treatment of infectious hydrocephalus

目的探讨脑室-腹壁外引流在治疗感染性脑积水中的优势及存在的问题。方法纳入384例颅内感染后继发脑积水的患者,经过脑室、腰大池外引流及常规抗感染治疗后,在两周内连续三次脑脊液内细菌培养阴性时行脑室-腹壁外引流,作为分流前的过渡治疗。等待脑脊液理化指标恢复正常,停药2周以上复查脑脊液指标依然稳定,行脑室-腹腔分流术。探讨该治疗方式在降低分流失败率方面的优势以及存在的问题。结果384例患者中,复查脑脊液内细菌阳性者244例(63.54%)。脑室-腹壁外引流术384例,其中孤立脑室腹壁外引流术37例,引流期间感染7例(治愈4例,死亡3例),死亡6例(感染3例,高血压脑出血1例,放弃1例出院后死亡,脑干功能衰竭1例)。脑室-腹壁外引流时间最短14 d,最长387 d,平均95.7 d。最终脑室-腹腔分流378例,随访1年,成功369例(97.62%),失败9例(分流后感染5例,单纯机械性堵塞4例),失败率2.38%,9例中死亡6例(感染2例,1例出院后4个月因癫痫持续发作死亡,1例出院后7个月不明原因死亡,高血压脑出血死亡1例,分流管堵塞死亡1例)。长时程体外引流(中位数69 d)与传统的短期体外引流(中位数13 d)相比,在提高颅内感染及感染性脑积水的治愈率方面有明确的帮助。结论脑室-腹壁外引流能够有效地降低感染性脑积水分流手术失败率。

Objective To explore the advantages and disadvantages of lateral ventricular abdominal-wall subcutaneous tunnel drainage in the treatment of infectious hydrocephalus.Methods 384 patients with hydrocephalus secondary to intracranial infection were included.After ventricular and lumbar cistern external drainage and routine anti infection treatment,ventricular abdominal wall external drainage was performed when the bacterial culture in cerebrospinal fluid was negative three times in two weeks as a transitional treatment before shunting.After waiting for the physical and chemical indexes of cerebrospinal fluid to return to normal,the indexes of cerebrospinal fluid were still stable after drug withdrawal for more than 2 weeks,and ventriculoperitoneal shunt was performed.The advantages and existing problems of this treatment in reducing the shunt failure rate were explored.Results Of 384 patients,244(63.54%)were positive for bacteria in cerebrospinal fluid.For all 384 cases,lateral ventricular abdominal-wall subcutaneous tunnel drainage were performed,including 37 of isolated ventricle,7 of infection during drainage(4 were cured)and 6 died(3 of infection,1 of hypertensive cerebral hemorrhage,1 of giving up,1 of brain stem failure).Finally,for 378 of the 384 cases,ventriculoperitoneal shunt were performed.The shortest drainage time was 14 days and the longest was 387 days,with an average of 95.7 days.One-year follow-up showed that 369 cases(97.62%)were successful,9 failed(5 of infection after shunt,4 of shunt simple mechanical blockage),and the failure rate was 2.38%.Of the 9 failed cases,6 died(2 of infection,1 died of epilepsy 4 months after discharge,1 died of unknown cause 7 months after discharge,1 died of hypertensive cerebral hemorrhage,1 died of shunt blockage).Compared with traditional short-term extracorporeal drainage(median 13 days),long-term extracorporeal drainage(median 69 days)had definite help in improving the cure rate of intracranial infection and infectious hydrocephalus.Conclusion Lateral ventricular abdominal-wall subcutaneous tunnel drainage can effectively reduce the failure rate of infectious hydrocephalus shunt.