婴幼儿化脓性脑膜炎致硬膜下积液的外科治疗

Surgical treatment of subdural effusion complicating purulent meningitis in infants

目的 分别探讨婴幼儿化脓性脑膜炎合并硬膜下积液的三种外科治疗的指征。方法 回顾分析我科收治的 38例化脓性脑膜炎合并硬膜下积液的婴幼儿 ,根据具体情况分别进行 (1)反复穿刺 ;(2 )持续引流 ;(3)穿刺加开颅手术或引流加开颅手术。全组病人随访 1年以上 ,观察其疗效。结果 10例行反复硬膜下穿刺病人 ,5例痊愈 ,3例好转 ,2例无效 ,6例行硬膜下引流病人 ,4例痊愈 ,2例无效 ,2 2例行开颅手术清除积液病人 ,2 0例痊愈 ,2例好转 ,全组无死亡。结论 化脓性脑膜炎合并的硬膜下积液如对大脑产生压迫 ,应及时进行外科治疗。具体方法应根据病程时间 ,积液蛋白含量而定。如治疗及时 ,方法正确 ,则大多数病人预后较好。

Objective To investigate the surgical treatment of subdural effusion complicating purulent meningitis in infants.Methods 38 cases of subdural effusion complicating purulent meningitis treated in our department in last 4 years were analyzed retrospectively.Repeated tapping was done in 10 cases.Persistent drainage in 6 cases.Taps followed by craniotomy in 20 cases.Drainage followed by craniotomy in 2 cases.Results In our series, 29 cases were perfectly cured,5 cases were improved, 4 cases no improvment.Conclusions If the subdural effusion compress the brain, surgical treatment should be performed without delay.The choice of treatment depends on the period of the disease and protein content of the effusion.Majority of patients have good prognosis under proper treatment.