耳源性颅内并发症的临床分析

Clinical analysis of otogenic intracranial complications

目的探讨耳源性颅内并发症的临床特点及诊治措施。方法回顾分析2003～2010年我科收治的21例耳源性颅内并发症患者的临床资料,病例包括脑脓肿9例、脑膜炎5例、静脉窦血栓性静脉炎4例、硬膜外脓肿3例,继发于胆脂瘤型中耳炎14例、骨疡型中耳炎3例、隐蔽性中耳炎2例、Modini畸形2例。21例均行耳部及头颅CT平扫检查,其中6例未发现颅内病变,经行磁共振成像(MRI)检查后确诊。分别行单纯乳突根治术8例、乳突根治术+脑脓肿穿刺引流6例、乳突根治术+颅钻孔脑脓肿引流1例、乳突根治术+脑脓肿切除术1例、乳突根治术+静脉窦切开脓肿清除及血栓取出2例、外淋巴漏修补术2例。结果随访1～2年,1例死亡,其余20例治愈,其中19例干耳,1例术腔仍有少量分泌物。全部患者颅内并发症无复发。结论胆脂瘤型和骨疡型中耳炎仍是耳源性颅内并发症的最常见病因,应提倡对这两种危险性中耳炎早期进行手术治疗。临床高度怀疑颅内并发症,CT平扫阴性病例,需行MRI检查。乳突切除进路的显微微创手术有效,无需开颅。

Objective To investigate the clinical features,diagnosis and treatment of otogenic intracranial com- plications. Methods Data of 21 patients with otogenic intracranial complications hospitalized from 2003 to 2010 were analyzed retrospectively. These patients included 9 cases with otogenic brain abscess,5 with otogenic meningitis, 4 with otogenic sinus thrombophlebitis and 3 with otogenic epidural abscess. Fourteen patients occurred secondary to cholesteatoma otitis media, 3 to bone abscess otitis media, 2 to masked mastoiditis and 2 to Modini deformity. All patients accepted CT scan examination of the ear and the brain. Six of them accepted MRI examination for the final diag- nosis. Simple mastoidectomy was performed in 8 cases, radical mastoidectomy with brain abscess drainage in 6 cases, radical mastoidectomy and cranial drill of brain abscess drainage in 1 case, mastoidectomy with brain abscess resection in 1 case, radical mastoidectomy with sinus incision and abscess thrombosis removal in 1 case and perilymph leak repalrment in 2 cases. Results All patients were followed up for 1 to 2 years. Twenty cases were cured, one patient died. Nineteen of the 20 cured cases got dry ear and one case suffered a little secretion in the surgical cavity. No recurrence was observed. Conclusions Cholesteatoma and bone abscess otitis media were the most common causes of otogenic intracra- nial complications. Early surgical treatment should be advocate for these two dangerous otitis. Cases with negative CT scan but with high suspicion of intracranial complications required further MRI examination. Furthermore,mastoidectomy approach was minimally invasive compared with craniotomy. （Chin J Ophthalmol and Otorhinolaryngol,2012 ,12 ：212-215 ）