神经内镜经鼻蝶窦垂体瘤切除术后颅内感染的危险因素分析及预防策略。
Analysis of risk factors and preventive strategies for intracranial infection after neuroendoscopic transnasal pituitary adenoma resection.
机构信息
Department of Neurosurgery, The People's Hospital of China Three Gorges University, Yichang, 443000, China.
Department of Neurosurgery, Dangyang People's Hospital, Yichang, China.
出版信息
BMC Neurosci. 2022 Jan 3;23(1):1. doi: 10.1186/s12868-021-00688-3.
OBJECTIVE
To analyse the risk factors for intracranial infection after neuroendoscopic transnasal pituitary adenoma resection (NTPAR) to provide a reference for the prevention and treatment of postoperative intracranial infection.
METHODS
The clinical data of 387 patients who underwent NTPAR in the Department of Neurosurgery of the First People's Hospital of Yichang from March 2013 to March 2021 were retrospectively analysed. The patients were divided into an infected group and a noninfected group according to the occurrence of intracranial infection. The detailed clinical data of the two groups were collected. Univariate and multivariate logistic regression was used to analyse the risk factors for intracranial infection after NTPAR.
RESULTS
Among the 387 surgical patients, 32 patients (8.27%) were in the intracranially infected group and 355 patients (91.73%) were in the noninfected group. The results of the univariate analysis suggested that age > 45 years, tumour size > 1 cm, operation time > 240 min, blood loss > 400 ml, Kelly Grade of cerebrospinal fluid (CSF) leakage > Grade 2, postoperative CSF leakage, lumbar cistern drainage and blood transfusion were the influencing factors for postoperative intracranial infection, while the results of multivariate logistic regression analysis implied that intraoperative CSF leakage (Kelly Grade > 2) and postoperative CSF leakage were independent influencing factors for intracranial infection after NTPAR, and perioperative use of antibiotics was an independent protective factor for postoperative intracranial infection.
CONCLUSIONS
There are a variety of risk factors for intracranial infection after NTPAR, which indicates that it is necessary to develop different repair strategies for CSF leakage according to the Kelly Grade, timely treatment of postoperative CSF leakage and perioperative use of antibiotics. These measures have been shown to effectively reduce the probability of intracranial infection after NTPAR.
目的
分析神经内镜经鼻蝶窦垂体瘤切除术（NTPAR）后颅内感染的危险因素，为术后颅内感染的防治提供参考。
方法
回顾性分析 2013 年 3 月至 2021 年 3 月宜昌市第一人民医院神经外科收治的 387 例 NTPAR 患者的临床资料。根据颅内感染的发生情况将患者分为感染组和未感染组。收集两组详细的临床资料。采用单因素和多因素 logistic 回归分析 NTPAR 后颅内感染的危险因素。
结果
387 例手术患者中，颅内感染 32 例（8.27%），未感染 355 例（91.73%）。单因素分析结果表明，年龄>45 岁、肿瘤大小>1cm、手术时间>240min、出血量>400ml、脑脊液（CSF）漏Kelly 分级>2 级、术后 CSF 漏、腰池引流、输血是术后颅内感染的影响因素，多因素 logistic 回归分析结果表明，术中 CSF 漏（Kelly 分级>2 级）和术后 CSF 漏是 NTPAR 后颅内感染的独立影响因素，围手术期使用抗生素是术后颅内感染的独立保护因素。
结论
NTPAR 后颅内感染的危险因素较多，提示根据 Kelly 分级制定不同的 CSF 漏修复策略，及时治疗术后 CSF 漏，围手术期使用抗生素，可有效降低 NTPAR 后颅内感染的概率。
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