鼻内镜颅底手术术后颅内感染临床研究
发布时间：2018-08-16 14:16
【摘要】：目的:鼻内镜技术是鼻外科领域的一场革命,随着该技术日趋的完善与成熟,鼻内镜手术从单纯的进行鼻部的手术逐渐向颅底延伸,越来越多的颅底病变可以通过鼻内镜手术来完成。由于鼻内镜颅底手术与传统的开放式颅脑手术相比,具有小切口微创的优势,在临床开展的日渐增多,与此同时鼻内镜颅底手术的并发症在临床上也越来越多见,术后颅内的感染就是其中较常见的一种。本研究主要是对鼻内镜颅底手术术后颅内感染因素进行探讨。方法1999年9月到2014年8月,天津市环湖医院耳鼻咽喉头颈外科有563例患者行鼻内镜颅底手术,包括颅底肿瘤患者227例,脑脊液鼻漏患者278例,脑膜脑膨出患者22例,视神经管减压术24例,空蝶鞍患者12例。其中颅底肿瘤患者主要包括垂体瘤、神经鞘瘤、脑膜瘤、颅咽管瘤、嗅神经母细胞瘤、脊索瘤等。对563例患者临床资料进行收集及总结,并对与颅内感染相关的因素进行单因素分析和多因素Logistic回归分析。将有显著意义的因素计算比值比(OR),以显著性水平p0.05为有统计学意义。结果:563例患者中,术后感染32例(5.68%);术后脑脊液鼻漏、颅底重建、既往颅底手术史、糖尿病是鼻内镜颅底手术术后颅内感染的独立危险因素,术后脑脊液鼻漏是术后颅内感染的最高独立危险因素(OR=7.76),术前抗生素的预防使用是鼻内镜下颅底手术后颅内感染唯一的保护性因素(OR=0.31),而年龄、性别、高血压、人工材料、术后应用抗菌药物7d对术后颅内感染影响不明显,差异无统计学意义。结论:1、鼻内镜颅底手术术后颅内感染可以是单个因素或者多种因素共同作用的结果,本研究中术后脑脊液漏、术后颅底重建、糖尿病、颅底手术史是术后颅内感染发生的独立危险因素。2、术后脑脊液鼻漏是术后颅内感染的最高独立危险因素(OR=7.76),术前抗生素预防性使用是术后发生颅内感染的保护性因素(OR=0.31)。3、术后抗生素长期的预防使用(7天)并不能降低术后颅内感染率,并且可能因此导致多重耐药菌的产生,增加治疗难度。4、鼻内镜颅底手术术后颅内感染发生率较低,一旦发生应及时诊断,尽早给予抗感染治疗。
[Abstract]:Objective: nasal endoscopic surgery is a revolution in the field of nasal surgery. With the improvement and maturity of the technique, endoscopic surgery gradually extends from simple nasal surgery to skull base. More and more skull base lesions can be done by endoscopic sinus surgery. Compared with the traditional open craniocerebral surgery, endoscopic skull base surgery has the advantage of small incision and minimally invasive, and the clinical complications of endoscopic skull base surgery are more and more common. Postoperative intracranial infection is one of the more common. The purpose of this study was to investigate the factors of intracranial infection after endoscopic skull base surgery. Methods from September 1999 to August 2014, 563 patients underwent endoscopic skull base surgery, including 227 patients with skull base tumor, 278 patients with cerebrospinal fluid rhinorrhea and 22 patients with meningeocele. There were 24 cases of optic canal decompression and 12 cases of empty Sella. The patients with skull base tumor include pituitary tumor, neurilemmoma, meningioma, craniopharyngioma, olfactory neuroblastoma, chordoma, etc. The clinical data of 563 patients were collected and summarized. The factors related to intracranial infection were analyzed by univariate analysis and multivariate Logistic regression analysis. The calculated ratio of significant factors was significantly higher than that of (OR), at a significant level (p0. 05). Results among 563 patients, 32 cases (5.68%) had postoperative infection, cerebrospinal fluid rhinorrhea, skull base reconstruction, history of skull base surgery, diabetes mellitus were independent risk factors of intracranial infection after endoscopic skull base surgery. Postoperative cerebrospinal fluid rhinorrhea is the most independent risk factor (OR=7.76) for postoperative intracranial infection. Prophylactic use of antibiotics is the only protective factor (OR=0.31) for intracranial infection after endoscopic skull base surgery (OR=0.31). There was no significant difference in postoperative intracranial infection after 7 days use of antimicrobial agents. Conclusion the intracranial infection after endoscopic skull base surgery may be the result of single factor or multiple factors. In this study, cerebrospinal fluid leakage, skull base reconstruction, diabetes mellitus, The history of skull base operation is the independent risk factor of postoperative intracranial infection. The cerebrospinal fluid rhinorrhea is the highest independent risk factor (OR=7.76) of postoperative intracranial infection. The prophylactic use of antibiotics before operation is the protective factor of postoperative intracranial infection. OR=0.31. 3. Long-term prophylactic use of antibiotics (7 days) did not reduce the postoperative intracranial infection rate. And this may lead to the production of multidrug resistant bacteria, increasing the treatment difficulty. 4. The incidence of intracranial infection after endoscopic skull base surgery is low. Once it occurs, it should be diagnosed in time, and anti-infection treatment should be given as soon as possible.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R765.9
本文编号：2186228
[Abstract]:Objective: nasal endoscopic surgery is a revolution in the field of nasal surgery. With the improvement and maturity of the technique, endoscopic surgery gradually extends from simple nasal surgery to skull base. More and more skull base lesions can be done by endoscopic sinus surgery. Compared with the traditional open craniocerebral surgery, endoscopic skull base surgery has the advantage of small incision and minimally invasive, and the clinical complications of endoscopic skull base surgery are more and more common. Postoperative intracranial infection is one of the more common. The purpose of this study was to investigate the factors of intracranial infection after endoscopic skull base surgery. Methods from September 1999 to August 2014, 563 patients underwent endoscopic skull base surgery, including 227 patients with skull base tumor, 278 patients with cerebrospinal fluid rhinorrhea and 22 patients with meningeocele. There were 24 cases of optic canal decompression and 12 cases of empty Sella. The patients with skull base tumor include pituitary tumor, neurilemmoma, meningioma, craniopharyngioma, olfactory neuroblastoma, chordoma, etc. The clinical data of 563 patients were collected and summarized. The factors related to intracranial infection were analyzed by univariate analysis and multivariate Logistic regression analysis. The calculated ratio of significant factors was significantly higher than that of (OR), at a significant level (p0. 05). Results among 563 patients, 32 cases (5.68%) had postoperative infection, cerebrospinal fluid rhinorrhea, skull base reconstruction, history of skull base surgery, diabetes mellitus were independent risk factors of intracranial infection after endoscopic skull base surgery. Postoperative cerebrospinal fluid rhinorrhea is the most independent risk factor (OR=7.76) for postoperative intracranial infection. Prophylactic use of antibiotics is the only protective factor (OR=0.31) for intracranial infection after endoscopic skull base surgery (OR=0.31). There was no significant difference in postoperative intracranial infection after 7 days use of antimicrobial agents. Conclusion the intracranial infection after endoscopic skull base surgery may be the result of single factor or multiple factors. In this study, cerebrospinal fluid leakage, skull base reconstruction, diabetes mellitus, The history of skull base operation is the independent risk factor of postoperative intracranial infection. The cerebrospinal fluid rhinorrhea is the highest independent risk factor (OR=7.76) of postoperative intracranial infection. The prophylactic use of antibiotics before operation is the protective factor of postoperative intracranial infection. OR=0.31. 3. Long-term prophylactic use of antibiotics (7 days) did not reduce the postoperative intracranial infection rate. And this may lead to the production of multidrug resistant bacteria, increasing the treatment difficulty. 4. The incidence of intracranial infection after endoscopic skull base surgery is low. Once it occurs, it should be diagnosed in time, and anti-infection treatment should be given as soon as possible.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R765.9
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相关期刊论文 前1条
1 纪冰;马筱玲;胡白;蔡朝阳;李华;;引起社区获得性皮肤软组织感染的病原菌分布及主要致病菌的药物敏感性分析[J];中国现代医学杂志;2007年03期
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