儿童急性乳突炎并发症治疗策略

The Complication of Acute Mastoiditis in Children Retrospective Study

目的探讨儿童急性乳突炎并发症的治疗策略。方法回顾性分析23例至少并发一项并发症的急性乳突炎患儿的临床资料,包括骨膜下脓肿16例,周围性面瘫5例(其中1例合并骨膜下脓肿),乙状窦血栓1例,骨膜下脓肿、迷路炎及败血症1例,所有并发症均于住院治疗前发生。所有患儿均住院行手术治疗,19例行乳突切开术,3例行改良乳突根治术,1例重症患儿行乳突根治术;其中11例患儿同时行鼓膜置管术,5例面瘫患儿同时行面神经减压术。结果 23例患儿中22例痊愈,1例患儿因并发败血症家属放弃治疗,自行出院后失访。9例患儿取乳突腔分泌物行细菌病原学检查,其中5例肺炎链球菌阳性。结论治疗儿童急性乳突炎并发症的首要目标为清除病灶,应首选手术治疗,辅以全身应用抗生素,绝大部分患儿预后良好,极少数因病灶累及颅内或并发全身症状预后不良。

Objective To study the treatment of the complications of acute mastoiditis in patients under 12 years old by analyzing the clinical features and outcome.Methods A total of 23 children suffered from acute mastoiditis and complications under 12 years old were the subjects for the retrospective study.The complications of acute mastoiditis were consist of subperiosteal abscess(16/23),facial nerve palsy(5/23),sigmoid or sinus thrombosis(1/23),the rest(1/23)suffered with labyrinthitis,fistula of semicircular canals and hematosepsis.All the patient underwent surgical treatment.19 cases underwent mastoidectomy,and 3 cases underwent modified mastoidectomy.All facial paralysis patients underwent facial nerve decompression at the same time.One child was treated with mastoid radical mastectomy.Of the 11 cases,the middle ear surgery was performed at the same time with tympanic membrane catheterization.Results A total of 22 children(95.7%)had been cured by antibiotics and surgery.Only one children’s patients gave up treatment as he suffered labyrinthitis,fistula of semicircular canals,hematosepsis and subperiosteal abscess.The positive rate of bacterial culture was 55.6%(5 out of 9 children)and streptococcus pneumoniae were found in all the positive cases.Conclusion The primary goal of treatment in children with acute mastoiditis is the removal of lesions surgical treatment should be preferred,with systemic antibiotics.Most of the children can be cured after surgical and medical treatment and only a few may fail because of the serious intracranial complications and poor health condition.