【摘要】 目的探讨儿童后颅窝肿瘤术后颅内感染的原因及诊治方法。方法天津市环湖医院八病区2010年4月16日至2014年4月30日收治的30例后颅窝肿瘤患儿,行开颅肿瘤切除等手术,按术后是否发生颅内感染分为感染组(5例)和无感染组(25例),分析感染可能的原因并结合临床诊治经验,探讨诊断及治疗的方法。结果本研究儿童后颅窝肿瘤术后颅内感染率为16.7%,对两组进行感染因素对比分析,发现多次手术、行第三脑室底造瘘(ETV)术或脑室-腹腔分流(V-P)术有统计学差异(χ~2=4.51,P=0.034),提示多次手术可能是术后感染的重要危险因素,特别是开颅术后发生脑积水而需继续行ETV或V-P术时;而手术时间>6h((χ~2=1.33,P=0.249)、颅内植入物(χ~2=1.47,P=0.225)、术后预防性使用抗生素(χ~2=0.596,P=0.440)、术后脑脊液漏(χ~2=3.69,P=0.55)、切口积液(χ~2=0.00,P=1.00)等因素两组无统计差异。感染后经积极引流+抗生素治疗,治愈时间8 d至3 w,治愈率为100%。结论反复多次颅内手术易导致儿童后颅窝肿瘤术后颅内感染,感染后早期发现、早期诊断,积极引流及抗生素治疗,预后仍较好。更多还原

【Abstract】 Objective The study aims to analyze the causes and treatment of intracranial infections after posterior fossa tumors craniotomy in children. Methods From April 16,2010 to April 30,2014,a total of 30 cases of pediatric patients with tumors of posterior cranial fossa in the Tianjin Huanhu Hospital,were performed with the craniotomy. All patients were divided into infection group( 5 cases) and non-infection group( 25 cases) according to intracranial infection situation. The possible causes and the methods of diagnosis and treatment were discussed.Results The post-operative infection rate was 16. 7%. There was significant statistical difference in multiple surgeries between two groups( χ~2= 4. 51,P = 0. 034),which suggested that multiple surgeries may be an important risk factor for post-operative infection. However,no statistical difference in operation time over 6 h,implantation of artificial materials in operation,prophylactic use of antibiotics after operation,cerebrospinal fluid leakage after operation was found between two groups. The drainage and antibiotic treatment was performed with a curative rate of100% and the curative time was 8 d to 3 w. Conclusion Multiple operation is the risk factor for the intracranial infections after posterior fossa tumors craniotomy in children. Early detection and diagnosis play an important role after infection,and the prognosis is satisfactory by the active drainage and antibiotic treatment.更多还原