内镜下经鼻蝶窦入路手术治疗垂体瘤术后继发颅内感染的危险因素研究
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摘要
目的:探讨内镜下经鼻蝶窦入路术后颅内感染(ICI)发生的危险因素。方法:回顾性分析2007年4月-2017年4月本院收治的垂体瘤患者368例的临床资料。分析患者术后ICI发生率,并根据是否发生ICI将其分为ICI组、非ICI组,收集两组临床资料,分析术后ICI发生的独立危险因素。结果:本研究368例患者中,发生ICI 31例(8.42%),未发生ICI 337例(91.58%);ICI组术后脑脊液漏、术后未使用抗生素、术后使用激素、再次手术的占比分别为29.03%、32.26%、77.42%、29.03%,均高于非ICI组的6.82%、13.65%、42.73%、9.50%,比较差异均有统计学意义(P<0.05);经COX回归性分析发现,术后脑脊液漏、术后使用激素、再次手术是垂体瘤术后ICI的独立危险因素(P<0.05),而术后及时使用抗生素是预防ICI的保护因素(P<0.05)。结论:内镜下经鼻蝶窦入路垂体瘤切除术后ICI的发生与术后脑脊液漏、术后使用激素、再次手术相关,而术后使用抗生素能降低ICI风险。
Objective:To investigate the risk factors for the occurrence of intracranial infection(ICI) after endoscopic transsphenoidal approach.Method:The clinical data of 368 patients with hypophysoma admitted to our hospital from April 2007 to April 2017 were retrospectively analyzed.The incidence of ICI after operation was analyzed.According to the occurrence of ICI,they were divided into ICI group and non ICI group,and two groups of clinical data were collected,and the independent risk factors of ICI after operation were analyzed.Result:Among the 368 patients,31 cases(8.42%) developed ICI,and 337 cases(91.58%) did not developed ICI.Cerebrospinal fluid leakage,postoperative antibiotics,postoperative use of hormone and reoperation in ICI group were 29.03%,32.26%,77.42% and 29.03% respectively,which were all higher than 6.82%,13.65%,42.73% and 9.50% in non ICI group,the differences were statistically significant(P<0.05).COX regression analysis showed that postoperative cerebrospinal fluid leakage,postoperative use of hormone and reoperation were independent risk factors for ICI after hypophysoma surgery(P<0.05),and the timely use of antibiotics was a protective factor to prevent ICI(P<0.05).Conclusion:The incidence of ICI after endoscopic endonasal transsphenoidal approach is related to postoperative cerebrospinal fluid leakage,postoperative use of hormone and reoperation,whilepostoperative antibiotic use can reduce ICI risk.
Objective:To investigate the risk factors for the occurrence of intracranial infection(ICI) after endoscopic transsphenoidal approach.Method:The clinical data of 368 patients with hypophysoma admitted to our hospital from April 2007 to April 2017 were retrospectively analyzed.The incidence of ICI after operation was analyzed.According to the occurrence of ICI,they were divided into ICI group and non ICI group,and two groups of clinical data were collected,and the independent risk factors of ICI after operation were analyzed.Result:Among the 368 patients,31 cases(8.42%) developed ICI,and 337 cases(91.58%) did not developed ICI.Cerebrospinal fluid leakage,postoperative antibiotics,postoperative use of hormone and reoperation in ICI group were 29.03%,32.26%,77.42% and 29.03% respectively,which were all higher than 6.82%,13.65%,42.73% and 9.50% in non ICI group,the differences were statistically significant(P<0.05).COX regression analysis showed that postoperative cerebrospinal fluid leakage,postoperative use of hormone and reoperation were independent risk factors for ICI after hypophysoma surgery(P<0.05),and the timely use of antibiotics was a protective factor to prevent ICI(P<0.05).Conclusion:The incidence of ICI after endoscopic endonasal transsphenoidal approach is related to postoperative cerebrospinal fluid leakage,postoperative use of hormone and reoperation,whilepostoperative antibiotic use can reduce ICI risk.
引文
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[16]张美彪,王列,罗科辉,等.开颅患者术后颅内感染相关因素分析与干预措施[J].中华医院感染学杂志,2016,26(3):589-590,596.
[17]范雁东,周凯,苏日青,等.垂体瘤术后垂体功能变化及激素替代研究[J].检验医学与临床,2017,14(Z1):244-245.
[18]周峰.垂体瘤术后垂体功能恢复情况及激素替代治疗的临床分析[J].实用临床医药杂志,2015,19(17):167-169.
[19]李冰.垂体腺瘤患者术后颅内感染危险因素及预防策略[J/OL].中华实验和临床感染病杂志(电子版),2017,11(4):409-412.
[20]王伟,贺强贵,陶礼钧,等.颅脑术后严重颅内感染患者脑脊液病原菌分布与治疗效果的研究[J].中华医院感染学杂志,2015,25(19):4478-4480.
[21]赵和兰,吴靖,王妍丹.神经外科幕上手术术后颅内感染危险因素与预防措施[J].浙江临床医学,2016,18(3):410-412.
[2]程钢戈,周岩,张晖,等.内镜下经单鼻孔蝶窦入路切除垂体腺瘤临床疗效观察(附47例报告)[J].解放军医学杂志,2015,40(5):404-407.
[3]焦风,王栋梁,刘波,等.鼻腔解剖变异对神经内镜经鼻蝶窦入路的影响[J].中华肿瘤防治杂志,2015,22(7):529-531.
[4]Chen K,Wu Y,Wang Q,et al.The methodology and pharmacokinetics study of intraventricular administration of vancomycin in patients with intracranial infections after craniotomy[J].J Crit Care,2015,30(1):1-5.
[5]中华人民共和国卫生部.医院感染诊断标准(试行)摘登(1)[J].新医学,2005,36(8):495.
[6]母义明.垂体瘤诊治进展[J].解放军医学杂志,2017,42(7):576-582.
[7]罗俊杰,戴永建,吕伟,等.颅脑幕上手术患者术后颅内感染的危险因素及转归分析[J].广西医科大学学报,2016,33(2):289-291.
[8]Kwon S J,Zhang F,Dordick J S,et al.Detection of cerebrospinal fluid leakage by specific measurement of transferrin glycoforms[J].Electrophoresis,2015,36(19):2425-2432.
[9]张伟,张玲霞,杨璐,等.垂体腺瘤患者术后脑脊液漏继发颅内感染的临床分析与预防措施研究[J].中华医院感染学杂志,2015,25(10):2306-2308.
[10]吴永铁,孙厚杰,张晗祥,等.抗感染治疗对脊柱骨折伴硬脊膜损伤术后脑脊液漏治疗结局及颅内感染影响[J].中华医院感染学杂志,2016,26(21):4928-4930.
[11]邵亚丽.垂体瘤术后垂体功能变化及激素替代治疗的临床效果[J].实用癌症杂志,2017,32(8):1244-1246.
[12]田崇佩,周凯,罗坤,等.内镜手术治疗性腺功能低下垂体瘤患者的疗效分析[J].新疆医科大学学报,2016,39(6):741-745.
[13]王琳,李强.垂体瘤患者术后肾上腺功能与激素替代的评估[J].中国综合临床,2016,32(8):757-760.
[14]刘海玉,周国平,李东峰,等.内镜下经鼻蝶窦入路行脑垂体瘤切除术后并发颅内感染相关因素分析[J].中华医院感染学杂志,2017,27(3):605-608.
[15]谢红兵,李冉,张天祥,等.垂体腺瘤患者术后脑脊液漏继发颅内感染的临床分析[J].中华医院感染学杂志,2016,26(7):1566-1568.
[16]张美彪,王列,罗科辉,等.开颅患者术后颅内感染相关因素分析与干预措施[J].中华医院感染学杂志,2016,26(3):589-590,596.
[17]范雁东,周凯,苏日青,等.垂体瘤术后垂体功能变化及激素替代研究[J].检验医学与临床,2017,14(Z1):244-245.
[18]周峰.垂体瘤术后垂体功能恢复情况及激素替代治疗的临床分析[J].实用临床医药杂志,2015,19(17):167-169.
[19]李冰.垂体腺瘤患者术后颅内感染危险因素及预防策略[J/OL].中华实验和临床感染病杂志(电子版),2017,11(4):409-412.
[20]王伟,贺强贵,陶礼钧,等.颅脑术后严重颅内感染患者脑脊液病原菌分布与治疗效果的研究[J].中华医院感染学杂志,2015,25(19):4478-4480.
[21]赵和兰,吴靖,王妍丹.神经外科幕上手术术后颅内感染危险因素与预防措施[J].浙江临床医学,2016,18(3):410-412.