【摘要】 目的 探讨颅内硬膜下积脓（subdural empyema,SDE）的临床特点、误诊原因及治疗方式选择。方法 回顾性分析安康市中心医院神经外科2020年11月至2023年2月收治的5例SDE患者资料，对其临床表现、治疗及预后进行分析。结果 5例患者均存在术前误诊，经手术治疗才确诊为SDE。其中2例青少年患者因病情迅速恶化伴脑疝，接受硬膜下积脓清除与去骨瓣减压，术后3～6个月行颅骨修补术，格拉斯哥预后量表（Glasgow outcome scale,GOS）评分均为5分；另3例中老年患者均行钻孔引流术，6个月后1例GOS评分5分，2例1分。结论 SDE发病率低、进展快、易误诊。早期确诊并依据患者年龄、全身状况及颅内压情况，个体化选择手术方式（开颅或钻孔引流），联合足量长程抗生素治疗，是改善预后的关键。更多还原

【Abstract】 Objective To explore the clinical features, causes of misdiagnosis, and optimal treatment strategies for intracranial subdural empyema(SDE). Methods The clinical data of five patients diagnosed with SDE at the Department of Neurosurgery at Ankang Central Hospital between November 2020 to February 2023 were retrospectively analyzed. Clinical presentations, treatments, and outcomes were systematically reviewed. Results All patients were preoperatively misdiagnosed, with the correct diagnosis confirmed intraoperatively. Two adolescent patients underwent SDE evacuation combined with decompressive craniectomy due to rapid clinical deterioration and cerebral herniation, both of whom underwent cranioplasty 3-6 months later and achieved a Glasgow Outcome Scale(GOS) score of 5. The other three elderly patients underwent burr-hole drainage, with one having a GOS score of 5 at the six-month follow-up, and the other two having a GOS score of 1. Conclusions SDE is rare but progresses rapidly. Timely and accurate diagnosis combined with appropriate surgical interventions can significantly improve the prognosis.更多还原