摘要：

目的: 探讨颞角-腹部皮下隧道外引流术治疗感染性孤立颞角疗效。方法: 收集2022年8月至2024年8月在中国医学科学院整形外科医院行颞角-腹部皮下隧道外引流术的26例感染性孤立颞角患者的临床和影像学资料，比较手术前后颞角最大截面积缩小率、颞角体积以及临床症状改善情况。结果: 共26例患者中21例直接行颞角-腹部皮下隧道外引流术；5例因颞角积脓先行颞角外引流术，待无脓液引出且复查脑脊液细菌培养阴性后再行颞角-腹部皮下隧道外引流术。12例行单纯颞角外引流术，12例行颞角外引流术合并侧脑室外引流术，2例行颞角外引流术合并孤立性第四脑室外引流术；1例因颞角持续未引出脑脊液拔除引流管，2例死亡，23例行二期改良脑室-腹腔分流术。术后3个月随访时，颞角最大截面积缩小率≥ 50%占比达88.46%（23/26），颞角体积较术前缩小（Z =-5.626，P = 0.000）；头痛（χ² = 17.053，P = 0.000）、脑疝（χ² = 6.125，P = 0.008）、意识障碍（χ² = 7.111，P = 0.004）、肌张力增高（χ² = 5.143，P = 0.016）、血压升高（χ² = 16.056，P = 0.000）、心动过速（χ² = 21.043，P = 0.000）等颅内高压和神经系统症状均较术前缓解。结论: 颞角-腹部皮下隧道外引流术治疗感染性孤立颞角，可在有效抗感染和净化脑脊液的同时，持续缓解颅内高压，为二期脑室-腹腔分流术创造安全条件，有助于提高分流手术成功率并缩短整体治疗周期。

关键词: 脑积水, 颞叶, 细菌感染, 脑脊髓液, 引流术, 腹壁, 脑室腹膜分流术

Abstract:

Objective: To evaluate the clinical value of temporal horn-abdominal subcutaneous tunnelled external drainage for the management of post-infectious trapped temporal horn (TTH). Methods: A retrospective analysis was performed on 26 patients who developed TTH after intracranial infection and underwent temporal horn-abdominal subcutaneous tunnelled external drainage in the Plastic Surgery Hospital, Chinese Academy of Medical Sciences from August 2022 to August 2024. Preoperative and postoperative clinical and imaging data were collected. The reduction rate of the maximum cross-sectional area of the temporal horn, the volume of temporal horn, and improvement rate of clinical symptoms were statistically analysed. Results: Among the 26 patients, 21 underwent direct temporal horn-abdominal subcutaneous tunnelled drainage surgery; 5 cases of temporal horn abscess were treated with temporal horn external drainage first, after no pus was discharged and the bacterial culture of cerebrospinal fluid (CSF)was negative, temporal horn-abdominal subcutaneous tunnelled external drainage was performed. Among them, 12 cases had simple temporal horn exteral drainage surgery, 12 cases had temporal horn exteral drainage surgery combined with lateral ventricle external drainage, 2 cases had temporal horn exteral drainage surgery combined with trapped fourth ventricle exteral drainage. One case had the drain removed because of persistent absence of CSF outflow, 2 cases died, and 23 cases underwent modified ventriculo-peritoneal shunt (VPS) at the second stage. A ≥ 50% reduction in the maximum cross-sectional area of the temporal horn was achieved in 88.46% (23/26) of the patients. The postoperative volume of temporal horn was significantly smaller than the preoperative volume (Z =-5.626, P = 0.000). Headache (χ² = 17.053, P = 0.000)、, cerebral herniation (χ² = 6.125, P = 0.008) consciousness disorders (χ² = 7.111, P = 0.004), increased muscle tone (χ² = 5.143, P = 0.016), elevated blood pressure (χ² = 16.056, P = 0.000), and tachycardia (χ² = 21.043, P = 0.000) had all improved compared to preoperative levels. Conclusions: Temporal horn-abdominal subcutaneous tunnelled external drainage for post-infectious TTH can effectively control infection and clear CSF while continuously relieving intracranial hypertension, creating safe conditions for second-stage VPS, and thereby helping to increase the shunt success rate and shorten the overall treatment period.

Key words: Hydrocephalus, Temporal lobe, Bacterial infections, Cerebrospinal fluid, Drainage, Abdominal wall, Ventriculoperitoneal shunt

中图分类号: 

• R741

• R651