鼻內(nèi)鏡顱底手術(shù)術(shù)后顱內(nèi)感染臨床研究
發(fā)布時間：2018-08-16 14:16
【摘要】：目的:鼻內(nèi)鏡技術(shù)是鼻外科領(lǐng)域的一場革命,隨著該技術(shù)日趨的完善與成熟,鼻內(nèi)鏡手術(shù)從單純的進(jìn)行鼻部的手術(shù)逐漸向顱底延伸,越來越多的顱底病變可以通過鼻內(nèi)鏡手術(shù)來完成。由于鼻內(nèi)鏡顱底手術(shù)與傳統(tǒng)的開放式顱腦手術(shù)相比,具有小切口微創(chuàng)的優(yōu)勢,在臨床開展的日漸增多,與此同時鼻內(nèi)鏡顱底手術(shù)的并發(fā)癥在臨床上也越來越多見,術(shù)后顱內(nèi)的感染就是其中較常見的一種。本研究主要是對鼻內(nèi)鏡顱底手術(shù)術(shù)后顱內(nèi)感染因素進(jìn)行探討。方法1999年9月到2014年8月,天津市環(huán)湖醫(yī)院耳鼻咽喉頭頸外科有563例患者行鼻內(nèi)鏡顱底手術(shù),包括顱底腫瘤患者227例,腦脊液鼻漏患者278例,腦膜腦膨出患者22例,視神經(jīng)管減壓術(shù)24例,空蝶鞍患者12例。其中顱底腫瘤患者主要包括垂體瘤、神經(jīng)鞘瘤、腦膜瘤、顱咽管瘤、嗅神經(jīng)母細(xì)胞瘤、脊索瘤等。對563例患者臨床資料進(jìn)行收集及總結(jié),并對與顱內(nèi)感染相關(guān)的因素進(jìn)行單因素分析和多因素Logistic回歸分析。將有顯著意義的因素計算比值比(OR),以顯著性水平p0.05為有統(tǒng)計學(xué)意義。結(jié)果:563例患者中,術(shù)后感染32例(5.68%);術(shù)后腦脊液鼻漏、顱底重建、既往顱底手術(shù)史、糖尿病是鼻內(nèi)鏡顱底手術(shù)術(shù)后顱內(nèi)感染的獨立危險因素,術(shù)后腦脊液鼻漏是術(shù)后顱內(nèi)感染的最高獨立危險因素(OR=7.76),術(shù)前抗生素的預(yù)防使用是鼻內(nèi)鏡下顱底手術(shù)后顱內(nèi)感染唯一的保護(hù)性因素(OR=0.31),而年齡、性別、高血壓、人工材料、術(shù)后應(yīng)用抗菌藥物7d對術(shù)后顱內(nèi)感染影響不明顯,差異無統(tǒng)計學(xué)意義。結(jié)論:1、鼻內(nèi)鏡顱底手術(shù)術(shù)后顱內(nèi)感染可以是單個因素或者多種因素共同作用的結(jié)果,本研究中術(shù)后腦脊液漏、術(shù)后顱底重建、糖尿病、顱底手術(shù)史是術(shù)后顱內(nèi)感染發(fā)生的獨立危險因素。2、術(shù)后腦脊液鼻漏是術(shù)后顱內(nèi)感染的最高獨立危險因素(OR=7.76),術(shù)前抗生素預(yù)防性使用是術(shù)后發(fā)生顱內(nèi)感染的保護(hù)性因素(OR=0.31)。3、術(shù)后抗生素長期的預(yù)防使用(7天)并不能降低術(shù)后顱內(nèi)感染率,并且可能因此導(dǎo)致多重耐藥菌的產(chǎn)生,增加治療難度。4、鼻內(nèi)鏡顱底手術(shù)術(shù)后顱內(nèi)感染發(fā)生率較低,一旦發(fā)生應(yīng)及時診斷,盡早給予抗感染治療。
[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.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R765.9
本文編號：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.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R765.9
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，本文編號：2186228
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