耳源性乙状窦血栓性静脉炎的诊治分析

陆金山; 艾合买提江·艾力江; 艾帕都拉·艾斯拉; 程秀琴; 吾买尔·亚森; 韩治国

doi:10.13201/j.issn.2096-7993.2023.02.008

耳源性乙状窦血栓性静脉炎的诊治分析

- 新疆维吾尔自治区人民医院耳鼻喉诊疗中心(乌鲁木齐，830000)

详细信息

通讯作者: 韩治国，E-mail：476311003@qq.com

中图分类号: R764.2

收稿日期: 2022-10-06

刊出日期: 2023-02-03

Diagnosis and treatment of otogenic sigmoid sinus thrombophlebitis

- Department of Otolaryngology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830000, China

More Information

Corresponding author: HAN Zhiguo, E-mail: 476311003@qq.com

Received Date: 06 October 2022

Publish Date: 03 February 2023

摘要

摘要: 目的探讨耳源性乙状窦血栓性静脉炎的诊疗策略。方法回顾性分析2014年11月—2021年11月在新疆维吾尔自治区人民医院耳鼻喉科住院并确诊为耳源性乙状窦血栓性静脉炎患者的临床表现、辅助检查、手术方案及抗凝治疗情况。结果 5例患者耳漏及听力减退病史5年以上，急性发作期均有头痛和发热，4例为驰张热，出现颅内外严重并发症，包括脑脓肿、脓毒血症、颅内出血、血性播散性肺炎等。颞骨高分辨率CT可见4例乙状窦骨壁有缺损，3例有乙状窦周、内侧积气，MRI乙状窦区T1WI可呈低信号、等信号、高信号，T2WI呈高信号，增强扫描呈窦壁强化。3例行头颅磁共振静脉造影，2例横窦、乙状窦、颈内静脉未显影，1例横窦、乙状窦未显影，颈内静脉纤细。5例均行乳突根治术+乙状窦壁肉芽或窦周脓肿切除，随访4~12个月恢复良好。结论无论乙状窦骨壁是否破坏，伴有头痛、发热的患者，需警惕乙状窦血栓性静脉炎的发生，早诊断早手术，防止病情进展。治疗以乳突根治术联合抗感染治疗为主，必要时结合抗凝以达到较好的预后。
- 乙状窦血栓性静脉炎 /
- 乳突根治术 /
- 脑脓肿
Abstract: Objective To summarize and analyze the clinical data of sigmoid sinus thrombophlebitis and discuss its treatment strategy.Methods The clinical manifestations, auxiliary examinations, surgical procedures and anticoagulant therapy of patients diagnosed with otosource sigmoid sinus thrombophlebitis in the Department of Otorhinolaryngology, People's Hospital of Xinjiang Uygur Autonomous Region from November 2014 to November 2021 were retrospectively analyzed.Results Five patients had a history of otorrhea and hearing loss for more than 5 years. They had headache during the acute episode, and 4 patients had drosive fever. They had severe complications, including brain abscess, sepsis, septic shock, intracranial hemorrhage, and hemorrhagic disseminated pneumonia. HRCT of temporal bone showed defects in the sigmoid sinus wall in 4 cases, and gas accumulation around and inside the sigmoid sinus in 3 cases. T1WI showed low signal, isosignal, and high signal in the sigmoid sinus area on MRI, and T2WI showed high signal in the sigmoid sinus area. The transverse sinus, sigmoid sinus and internal jugular vein were not developed in 2 cases, and the transverse sinus and sigmoid sinus were not developed in 1 case, and the internal jugular vein was thin. All 5 cases underwent radical mastoidectomy and resection of sigmoid sinus wall granulation or peritosinusitis abscess. The patients were followed up for 4-12 months and recovered well.Conclusion For the cases of sigmoid sinus bone wall destruction accompanied by headache and fever by HRCT, it is necessary to be alert to the occurrence of sigmoid sinus thrombophlegitis, early diagnosis and early surgery to prevent the progression of the disease. Radical mastoidectomy combined with anti-infection therapy is the main treatment, and anticoagulation is necessary to achieve a better prognosis.
- sigmoid sinus thrombophlebitis /
- radical mastoidectomy /
- brain abscess

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图 1 典型病例的临床资料

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表 1 5例患者的基本资料及临床表现

例序	年龄/岁	病因	病程/年	头痛/d	发热时间/d	体温/(℃)	眼底镜检查	听力检查	颈项强直	相关并发症
1	8	中耳胆脂瘤	8	20	10	39	视乳头水肿	传导性聋	阳性	颞枕、桥小脑脓肿，低蛋白血症
2	22	慢性中耳炎	7	21	21	39	正常	重度感音神经性聋	阳性	颞叶脑脓肿，硬膜外脓肿，桥小脑角区脓肿
3	28	中耳胆脂瘤	10	7	7	40	正常	未测	阴性	脓毒血症，感染性休克，蛛网膜下腔出血
4	56	中耳胆脂瘤	15	9	8	38	正常	混合性聋	阳性	桥小脑角区脑脓肿，脑膜炎，急性荨麻疹
5	8	急性乳突炎	5	7	7	41	视乳头水肿	传导性聋	阳性	脓毒血症，感染性休克，硬膜外脓肿，血行播散性肺炎

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表 2 5例患者的相关辅助检查及治疗情况

例序	白细胞/(×10⁹· L^-1)	降钙素原/ (ng· mL^-1)	细菌培养	CT		MRI			MRV	抗生素	术式	治疗结果
例序	白细胞/(×10⁹· L^-1)	降钙素原/ (ng· mL^-1)	细菌培养	骨壁是否破坏	是否积气	T1WI	T2WI	增强	MRV	抗生素	术式	治疗结果
1	18.92	0.33	阴性	有	无	等	高	未做	未做	万古霉素美罗培南	小脑脓肿切除术；24 d后开放式乳突根治术	愈合
2	14.76	0.08	缓症、星座链球菌	有	无	高	高	未做	未做	万古霉素头孢曲松	颞叶脓肿切除术；14 d后开放式乳突根治术；7 d后再次颞叶脓肿切除	愈合
3	17.68	24.19	阴性	有	有	低	高	强化	横窦、乙状窦、颈内静脉未显影	美罗培南甲硝唑	胸腔闭式引流；10 d后开放式乳突根治术	愈合
4	11.90	0.33	奇异变形菌	有	有	等	高	强化	横窦、乙状窦未显影，颈内静脉纤细	美罗培南	左开放式乳突根治术+鼓室成形术；16 d后左侧桥脑小脑角脓肿切除	愈合
5	16.57	31.09	阴性	无	有	等	高	强化	横窦、乙状窦、颈内静脉未显影	美罗培南万古霉素甲硝唑	开放式乳突根治术+乙状窦周脓肿切除术	愈合

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