摘要：

目的: 探讨生理盐水冲洗手术通道和术中细菌学检验对预防与治疗经鼻内镜颅底手术后颅内感染的可行性和临床意义。方法: 分析2018年9月至2024年12月在天津市环湖医院行经鼻内镜颅底手术的307例患者临床资料，根据手术通道消毒方法分为碘伏组（171例）和生理盐水组（136例），生理盐水组80例患者于术中进行细菌学检验，并记录手术通道细菌培养结果和术后颅内感染发生率。结果: 碘伏组和生理盐水组术后颅内感染发生率分别为3.51%（6/171）和1.47%（2/136），组间差异无统计学意义（Fisher确切概率法：P = 0.308）。生理盐水组80例行细菌学检验患者中，术前鼻腔冲洗前和冲洗后定植菌培养阳性率为61.25%（49/80）和51.25%（41/80），以表皮葡萄球菌、肺炎克雷伯菌和草绿色链球菌为主；术中开放蝶窦后定植菌培养阳性率为36.25%（29/80），以肺炎克雷伯菌、表皮葡萄球菌和草绿色链球菌常见，另有4种细菌（产酸克雷伯菌、毗邻颗粒链球菌、屎肠球菌和阴沟肠杆菌）鼻腔未见；术后颅内感染发生率为1.25%（1/80），脑脊液细菌学检验结果与术前鼻腔定植菌培养一致。结论: 经鼻内镜颅底手术后颅内感染的病原菌来源于鼻腔定植菌，生理盐水冲洗手术通道可降低术后颅内感染发生率，术中细菌学检验有助于指导术后治疗。

关键词: 神经内窥镜检查, 手术后并发症, 细菌感染, 脑疾病, 氯化钠, 碘附

Abstract:

Objective: To evaluate the value of nasal normal saline irrigation and bacteriological testing of the surgical pathway in the prevention and treatment of intraoperative intracranial infection after endoscopic endonasal skull base surgery. Methods: A retrospective analysis was conducted on the clinical data of 307 patients who underwent endoscopic endonasal skull base surgery in Tianjin Huanhu Hospital between September 2018 and December 2024. Patients were divided into 2 groups based on the nasal disinfection method: the povidone-iodine disinfection group (n = 171) and the normal saline irrigation group (n = 136). Intraoperative bacterial culture was performed 3 times in 80 patients in the normal saline irrigation group. Primary outcome measures were results of bacterial culture from the surgical pathway and the incidence of postoperative intracranial infection. Results: Postoperative intracranial infection occurred in 6 patients (3.51%) in the povidone-iodine disinfection group and 2 patients (1.47%) in the normal saline irrigation group, with no statistically significant difference between the 2 groups (Fisher's exact probability: P = 0.308). Among 80 patients of the normal saline irrigation group who underwent bacteriological testing, nasal colonizing bacteria were cultured in 49 cases before nasal irrigation and 41 cases after irrigation. The top 3 most common bacteria were Staphylococcus epidermidis, Klebsiella pneumoniae, and Streptococcus viridans in both periods. Colonizing bacteria were detected in sphenoid sinus of 29 cases, with the top 3 being Klebsiella pneumoniae, Staphylococcus epidermidis, and Streptococcus viridans; additionally, 4 bacterial species not detected in the nasal cavity were identified, namely Klebsiella oxytoca, Granulicatella adiacens, Enterococcus faecium, and Enterobacter cloacae. Intracranial infection occurred in 1 out of 80 patients who underwent bacteriological testing, and the bacterial strain isolated from the cerebrospinal fluid was consistent with the colonizing bacteria in the nasal cavity and paranasal sinuses. Conclusions: Normal saline irrigation of the surgical pathway can reduce the incidence of intracranial infection, and nasal disinfection with povidone-iodine is an unnecessary measure. The pathogenic bacteria of postoperative intracranial infection in endoscopic endonasal skull base surgery patients originate from nasal colonizing bacteria. Intraoperative pathogenic bacteria detection is helpful for guiding the treatment of postoperative intracranial infection.

Key words: Neuroendoscopy, Postoperative complications, Bacterial infections, Brain diseases, Sodium chloride, Iodophors

中图分类号: 

• R741