儿童脑脓肿

Brain abscess in children

目的分析总结儿童脑脓肿的临床发病特点及治疗经验。方法对1994年12月～2001年9月收治的34例脑脓肿患儿的临床资料进行回顾性分析。结果34例儿童患者占同期全年龄组脑脓肿患者的42.5%(34/80),平均发病年龄为6.68岁,男女之比为1.4∶1。以邻近感染扩散和血源性播散为主要感染途径;脓肿分布以额顶区较为多见(57.9%,22/38);多房性、多发性脓肿和巨大脓肿是儿童脑脓肿特点之一;脓液细菌培养阳性率为38.1%(8/21),以链球菌为多见。14.7%(5/34)的患儿接受单纯穿刺抽吸脓腔冲洗;85.3%(29/34)的患儿施行手术切除,其中全切除率为82.8%(24/29)。1例穿刺后死亡。随访18例,复发率为27.8%(5/18)。结论儿童脑脓肿预后较差。早期诊断、及时进行药物与外科手术联合治疗可望提高疗效。

Objective To analyze and summarize the clinical characteristics and therapeutic experi-ences in children brain abscess(BA).Methods The clinical data of34children patients with brain abscess during December1994to September2001were retrospectively analyzed,especially focused on pathogenesis,route of infection,clinical manifestation,bacteriological examination,neuroimaging findings and surgical treatment.Re sults The34children patients accounted for42.5%(34/80)of all brain abscess patients with different ages treated in the hospital during the same period.The average onset age of the children patients was6.68years and the ratio of males vs.females was1.4:1.The dissemination of bacterium from adjacent infec-tion focus or through blood flow was the main infection route,and the abscess was frequently located in frontal-parietal lobes57.9%(22/38),the BA characterized with multilocular,multiple or huge abscess in chil-dren.The positive rate of bacteria culture with pus was38.1%(8/21)in children BA patients and streptococ-cus was the dominant pathogenetic bacteria.Of the patients14.7%(5/34)received puncture,aspiration and vomica irrigation alone,while the other85.3%received surgical resection,among the operations the total re-moval rate was82.8%(24/29).There was1patient died after BA puncture.The recurrences rate was27.8%(5/18)in the following up of18patients.Con clusion The prognosis of BA in children was poor.Early diag-nosis and treatment with combined medicine and surgical therapy in time will improve the therapeutic effect.[