Objective: To compare the diagnosis and treatment experience of brain abscesses and improve prognosis. Methods: The data of 302 patients of brain abscess at Department of Neurosurgery in Tianjin Medical University General Hospital from 1980 to 2014 was analyzed retrospectively. There were 215 male and 87 female patients aged from 11 to 82 years with mean age of (30±8) years. The patients was divided into 1980-2001 group and 2002-2014 group according to different diagnosis and the treatment methods. The therapy methods include operation and conservative treatment. There were 196 cases received operation, including 95 cases of excision, 89 cases of ventriculopuncture, 12 cases of excision after ventriculopuncture, 106 cases received drug conservative therapy. Two groups of information including clinical manifestation, abscess location, therapeutic effect and prognosis were compared by χ(2) test. Results: Compared to 1980-2001 group, adjacent infection incidence declined(χ(2)=8.000, P=0.005). The ratio of single abscess declined and multiple abscess increased(χ(2)=11.060, P=0.001), the infection proportion of frontal lobe and temporal lobe decreased(χ(2)=9.080, P=0.003; χ(2)=15.440, P=0.000). The ratio of headache and vomit and papilledema declined significantly(χ(2)=23.290, P=0.000; χ(2)=21.020, P=0.000; χ(2)=2.290, P=0.001). Total mortality of 302 patients were 23 cases and 5 cases of 1980-2001 group and 2002-2014 group (10.4% vs. 6.3%, χ(2)=1.180, P=0.277). However, there were statistical difference in postoperative mortality between both groups (14.4% vs. 4.0%, χ(2) =3.880, P=0.049). Conclusion: With the application of antibiotics and the development of neurosurgical techniques, the prognosis of brain abscess has been improved.
目的：比较不同时期脑脓肿的诊疗经验和预后。 方法：回顾性分析1980—2014年天津医科大学总医院神经外科收治的302例脑脓肿患者的临床资料。男性215例，女性87例，年龄11～82岁，平均年龄(30±8)岁。根据诊断和治疗方法将患者分为1980—2001组和2002—2014组。治疗方法包括手术治疗和药物保守治疗，其中手术治疗患者196例(单纯切除95例，穿刺引流89例，穿刺引流后切除12例)，药物保守治疗106例。采用χ(2)检验比较两组患者的一般资料、感染因素、临床表现和体征、脓肿部位和治疗效果等。 结果：与1980—2001组相比，2002—2014组脑脓肿患者感染因素中邻近部位感染比例下降(χ(2)＝8.000，P＝0.005)；单发脓肿比例下降，多发脓肿比例升高(χ(2)＝11.060，P＝0.001)；额叶、颞叶部位感染比例下降(χ(2)＝9.080，P＝0.003；χ(2)＝15.440，P＝0.000)；头痛、呕吐症状比例下降(χ(2)＝23.290, P＝0.000；χ(2)＝21.020，P＝0.000)，视乳头水肿比例下降(χ(2)＝2.290，P＝0.001)；细菌培养阳性率比例下降(χ(2)＝50.280，P＝0.000)，差异均有统计学意义。1980—2001组和2002—2014组病死例数分别为23例(10.4%)和5例(6.3%)，差异无统计学意义(χ(2)＝1.180，P＝0.277)；两组术后病死例数分别为21例(14.4%)和2例(4.0%)，差异有统计学意义(χ(2)＝3.880，P＝0.049)。 结论：随着抗菌药物、影像技术不断更新及显微手术的不断发展，脑脓肿患者的预后得到了改善。.
Keywords: Brain abscess; Mortality; Treatment.