摘要
目的探讨近25年来耳源性颅内并发症的临床特点和诊治措施。方法采用回顾性分析方法，对1982至1987年和1997年至2006年北京协和医院耳鼻咽喉科收治的耳源性颅内并发症患者的临床资料进行总结。14例患者中，男10例，女4例，发病年龄12—62岁，平均32．1岁；颅内病变与耳部病变均为同侧。耳部病变中，中耳胆脂瘤12例，非胆脂瘤性慢性化脓性中耳炎2例。颅内并发症中，大脑颞叶脓肿6例次、小脑脓肿4例次、乙状窦周围脓肿3例次、乙状窦血栓性静脉炎和脑膜炎2例次，硬脑膜外脓肿1例次。人院主诉中，头痛13例次、高热11例次和恶心呕吐10例次。所有患者均有耳道溢脓。脓液培养结果显示，变形杆菌（5例次）、表皮葡萄球菌（3例次）和绿脓杆菌（2例次）最多见。所有患者均急诊行乳突单凿术或乳突根治术。采用抗生素＋甘露醇联合方案者12例，单独使用抗生素治疗者2例。结果14例患者均临床治愈后出院，治愈率100％。1982至1987年间的4例患者出院后失随访，可以随访到的5例患者中，目前情况良好者4例（随诊时间为22．5至24．4年，平均23．8年）；死亡1例（出院后19．2年死于心脑血管疾病）。1997至2006年间的5例患者中，其中1例因乙状窦周围脓肿入院行乳突根治术和抗感染治疗，假性治愈出院后第24天突发高热、恶心和意识障碍，经MRI证实为颞叶脓肿，再次入院治疗，治愈后出院；所有这5例患者随访至今情况良好，随访时间1．5—10．6年，平均6．5年。结论耳源性颅内并发症更好发于男性、年轻患者，颅内并发症以大脑脓肿、小脑脓肿和脑膜炎最为多见，不同文献报道的菌培养结果各异。随着时间的推移，致病菌、并发症的类型和选用的抗生素均有演变，及时的乳突手术脓腔开放引流和药物联合治疗有效地提高了本病的治愈率。CT、MRI对
Objective To analyze the clinical features and treatment protocols of otogenic intracranial complications in Peking Union Medical College ospital. Methods Retrospective study of 14 patients （10 males and 4 females, aged between 12 -62 years, mean age 32. 1 years） hospitalized from 1982- 2006. Twelve cases were otitis media （OM） with cholesteatoma, the other 2 cases were non- cholesteatomatous OM. All the otogenic intracranial complications located at the same sides as otologic disorders. Brain abscess was the most common type of orogenic complications and Proteus was the most common microorganism detected. Suppurative ear discharge, headache, high fever and nausea with vomiting were the most common clinical manifestations with very high incidences. All the patients received combined protocols of mastoid surgeries and antibiotics treatment. Results All the 14 patients recovered clinically. For patients discharged before 1987, there were 4 patients followed up for 22. 5 - 24.4 years with a mean time of 23.8 without recurrence, 1 patient died of cardiovascular disease 19. 2 years later after discharge, 4 patients lost follow-up. For the 5 patients discharged after 1997 ,brain abscess recurred in one patient with pseudo-recovery after 24 days and he fully recovered after re-hospitalization and treatment. All the five patients were followed up for 1.5 years to 10. 6 years with a mean time of 6. 5 years without recurrence. Conclusions Youngsters and males seemed to be more vulnerable. Brain abscess was the most common intracranial complication and Proteus was the most common pyogenic microorganism. Combination of mastoid surgery and antibiotics were essential for effectively controlling the intracranial complications and improving the recovery. CT and MRI were essential for correct diagnosis betimes and MRI seemed to have a better performance.
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2008年第11期801-805,共5页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
关键词
中耳炎
手术后并发症
脑脓肿
Otitis media
Postoperative complications
Brain abscess
