Smith S J, Ughratdar I, MacArthur D C
Department of Neurosurgery, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, United Kingdom.
Br J Neurosurg. 2009 Aug;23(4):412-7. doi: 10.1080/02688690902887549.
Cerebral abscess is an emergency requiring urgent drainage via craniotomy or burrhole aspiration. We examine whether initial method of drainage affects outcome and important characteristics in patients with cerebral abscess. This is a retrospective analysis of 62 patients operated on in our unit with a loculated infected cerebral collection in the years 2003-2007 inclusive. Full statistical analysis was performed using data appropriate tests. Burrhole and craniotomy groups were evenly matched with no difference in any demographic factors. Surgical method made no difference to rate of re-operation (p = 0.276), antibiotic duration (p = 0.648), discharge GCS (p = 0.509), length of stay (p = 0.647) or GOS (p = 0.968). There was a trend to worsened outcome with delay to surgery (p = 0.132) with delayed patients requiring longer hospital stays (p < or = 0.005). Patients requiring a longer antibiotic duration had worse outcomes (p < or = 0.005). Surgical method did not have a significant effect on outcome, so burrhole aspiration with its advantages in terms of speed and scale of surgery should be strongly considered. Delay had an adverse affect, so operation should be as expeditious as possible whenever the differential diagnosis includes abscess, diagnosis of which may be aided by advanced magnetic resonance imaging techniques.
脑脓肿是一种需要通过开颅手术或钻孔抽吸进行紧急引流的急症。我们研究了初始引流方法是否会影响脑脓肿患者的预后及重要特征。这是一项对2003年至2007年（含）期间在我们科室接受手术治疗的62例局限性感染性脑脓肿患者的回顾性分析。使用适当的数据检验进行了全面的统计分析。钻孔引流组和开颅手术组在任何人口统计学因素上均无差异，手术方法对再次手术率（p = 0.276）、抗生素使用时间（p = 0.648）、出院时格拉斯哥昏迷评分（GCS）（p = 0.509）、住院时间（p = 0.647）或格拉斯哥预后评分（GOS）（p = 0.968）均无影响。手术延迟会有预后恶化的趋势（p = 0.132），延迟手术的患者住院时间更长（p≤0.005）。抗生素使用时间较长的患者预后较差（p≤0.005）。手术方法对预后没有显著影响，因此应强烈考虑钻孔抽吸术，其在手术速度和规模方面具有优势。手术延迟有不利影响，因此只要鉴别诊断包括脓肿，手术应尽可能迅速进行，先进的磁共振成像技术可能有助于脓肿的诊断。
