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摘要: 目的 分析儿童中耳乳突炎合并乙状窦血栓性静脉炎的临床特点，探讨诊疗原则，提高对该类疾病的认识，加强早期识别。 方法 回顾性分析以发热/头痛首诊于感染内科、神经内科住院治疗，于我科行中耳乳突手术的6例中耳乳突炎合并乙状窦血栓性静脉炎患儿的临床资料。所有患儿均有完善的耳内镜、听力学、影像学及病原学检查。总结临床表现、病原学特点、治疗方法及预后情况，随访时间为3~6个月。 结果 6例患儿均以发热/头痛等颅内并发症首诊于内科；追问病史1个月内均有耳痛、流脓、听力下降等耳部症状；听力学检查传导性听力下降5例，全聋1例。影像学MRI、MRV+MRA检查提示：中耳感染合并乙状窦血栓性静脉炎6例，其中3例乙状窦内有血栓。6例患儿均接受手术治疗：2例行完璧式乳突根治术+鼓膜置管术；4例行完璧式乳突根治术。病原学检查，耳道/术中脓液病原培养肺炎链球菌3例，铜绿假单胞菌1例，阴沟肠杆菌复合群1例，1例未测出。术后病理6例均为炎性肉芽。随访3~6个月，定期复查颅内及中耳病变无复发。 结论 患儿反复发热、头痛，若近期伴有急慢性中耳炎病史，应警惕乙状窦血栓性静脉炎的发生，需及时行影像学检查以明确诊断。一旦明确诊断，手术清除乙状窦周围病变、通畅引流结合抗生素治疗是最为直接有效的治疗方法，必要时给予抗凝治疗。及时诊断、多学科协作、原发灶及合并症处理时机的准确把握对疾病的治疗至关重要。Abstract: Objective To analyze the clinical characteristics of middle ear mastoiditis combined with sigmoid sinus thrombophlebitis in children. Methods Author retrospectively analyzed the clinical data of 6 children with middle ear mastoiditis combined with sigmoid sinus thrombophlebitis who were hospitalized in the Department of Infectious Diseases and Department of Neurology with first diagnosis of fever/headache, and subsequently underwent middle ear mastoidectomy in our department. All patients underwent comprehensive otoscopic, audiologic, imaging, and pathogenetic examinations. Clinical manifestations, pathogenetic features, treatment methods and prognosis were summarized, and the follow-up period was 3-6 months. Results All 6 cases were first diagnosed with intracranial complications such as fever and headache in the internal medicine department. Within one month, all patients developed ear symptoms including pain, discharge, and hearing loss. Audiologic examination revealed conductive hearing loss in five cases and total deafness in one case. MRI, MRV and MRA examinations suggested that there were 6 cases of middle ear infection combined with thrombophlebitis of the ethmoid sinus, of which 3 cases had thrombus in the ethmoid sinus. 6 cases received surgical treatments: 2 cases of radical mastoidectomy+grommet Insertion, and 4 cases of radical mastoidectomy. Pathogenetic examination identified Streptococcus pneumoniae in three cases, Pseudomonas aeruginosa in one case, Enterobacter cloacae complex in one case, and no pathogens were detected in one case. Postoperative pathology was inflammatory granulation in all 6 cases. Follow-up was 3-6 months with no recurrence of intracranial and middle ear lesions on regular review. Conclusion Children with recurrent fever, headache, and a recent history of acute and chronic otitis media should be evaluated for the possibility of sigmoid sinus thrombophlebitis, and imaging tests should be performed in a timely manner to clarify the diagnosis. Once diagnosed, surgery to remove the lesions around the ethmoid sinus, smooth drainage combined with antibiotic therapy is the most direct and effective treatment, and anticoagulation therapy is given when necessary. Timely diagnosis, multidisciplinary collaboration, and accurate timing of the management of primary foci and comorbidities are crucial to the treatment of the disease.
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Key words:
- children /
- otomastoiditis /
- thrombophlebitis /
- surgery
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表 1 6例患儿的临床信息、相关辅助检查及诊疗情况
例序 首诊症状 耳部查体 颞骨CT：乙状窦壁骨质破损 颅脑MRI、MRV 听力 病原 术中所见 手术方式 乙状窦血栓 乙状窦壁增厚 脓苔 乙状窦壁骨质缺损 例1(抗凝) 反复发热 耳流脓、耳后肿胀 √ √ 重度传导聋 肺炎链球菌 √ √ 完璧式乳突根治 例2(抗凝) 反复发热 鼓膜完整、增厚 √ √ 中度传导聋 肺炎链球菌 √ √ 完璧式乳突根治 例3 反复发热 鼓膜完整，鼓室积液 √ √ 中度传导聋 未检测出病原 质脆肿物、未见脓性分泌物 √ 完璧式乳突根治 例4 反复发热 鼓膜充血、鼓室内积脓 √ √ 中度传导聋 肺炎链球菌 √ √ 完璧式乳突根治+鼓膜置管 例5 反复发热 耳道流脓 √ √ 全聋 铜绿假单胞菌 √ √ 完璧式乳突根治 例6(抗凝) 持续头痛 鼓膜色暗红，见积液 √ √ 中度传导聋 阴沟肠杆菌复合群 √ √ 完璧式乳突根治+鼓膜置管 
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