耳源性乙状窦血栓性静脉炎6例诊治分析

Management of otogenic sigmoid sinus thrombosis

目的探讨耳源性乙状窦血栓性静脉炎的发病机制、临床表现及治疗方法。方法回顾分析2015年1月~2018年1月在我科住院治疗的6例乙状窦血栓性静脉炎的病例资料,分析其临床表现、致病菌、手术方法、术中探查结果及术后随访情况。结果6例乙状窦血栓性静脉炎患者中,成人4例,均为长期中耳胆脂瘤患者,破坏乙状窦前壁,合并感染致病;儿童2例,均为急性中耳炎直接感染致病。除1例老年患者外,其余患者均无弛张热、头痛症状。所有患者均行乳突切除,减压窦壁,清除肉芽组织,联合抗感染治疗2周,均未进行抗凝治疗。所有病例均治愈,无神经功能缺失后遗症。术后6个月复查磁共振成像(MRI)及磁共振静脉造影(MRV)未见复发,其中1例乙状窦再通。结论耳源性乙状窦血栓性静脉炎在目前临床症状不典型,诊断有赖于影像学检查辅助,特别是MRV成像可作为诊断金标准。儿童与成人病因不一致,儿童多为急性中耳炎并发,成年患者多是由于中耳胆脂瘤直接破坏乙状窦骨壁,感染蔓延导致。乳突根治术联合抗感染治疗是有效的治疗方法。

Objective To discuss the pathogenesis,clinical manifestations and treatment of otogenic sigmoid sinus thrombosis.Methods A retrospective review was performed.Six patients who were treated between 2015 and 2018 were included.Results Six patients were included.Four patients were adults with long-term middle ear cholesteatoma,which destroyed the anterior wall of the sigmoid sinus and caused SST.The other two cases were children whose sigmoid sinus were directly infected by acute otitis media.Except one elderly patient,all the other patients did not experience“Picket Fence”fever or persistent headache.All patients underwent mastoidectomy and then treated with antibiotics for 2 weeks.Anticoagulaion therapy were not applied.All cases were cured without any neurological deficits.Magnetic resonance imaging(MRI)and magnetic resonance venogram(MRV)were rechecked 6 months later,showing that there were no recurrence case but one sigmoid sinus was recanalized.Conclusions The clinical symptoms of otogenic sigmoid sinus thrombosis are atypical.The diagnosis of it depends on imaging examination,especially MRV imaging which can be the gold standard.Children and adults have inconsistent causes.The children are mainly complicated by acute otitis media,and the adult patients are mostly caused by the middle ear cholesteatoma.Mastoidectomy combined with antibiotics might be an effective treatment.