24例耳源性脑脓肿的临床分析

Analysis of clinical features of 24 cases with otogenic brain abscess

摘要:

目的总结分析耳源性脑脓肿的临床特点，探讨其治疗策略。方法回顾性分析2007年1月—2023年12月在新疆维吾尔自治区人民医院住院并确诊为耳源性脑脓肿患者24例的临床表现、辅助检查及治疗、随访情况。结果 24例患者均有中耳炎病史，17例有头痛症状，所有患者均完善头颅CT，其中19例完善头颅MRI；颞叶脓肿16例，小脑脓肿6例，两者兼有者2例。12例先行脑脓肿切除或引流术，再转入耳鼻咽喉科行乳突根治术；5例先行乳突根治术，二期行脑脓肿切除或引流术；1例选择保守治疗。术后随访6~24个月，20例治愈，2例患者死亡，2例失访。结论耳源性脑脓肿多发生于中耳胆脂瘤，患者头痛并颞骨CT提示中、后颅窝骨质破坏时，应警惕脑脓肿发生，应尽早给予足量足疗程敏感抗菌药物，根据脓肿位置、大小、是否涉及功能区及患者免疫状况、年龄、全身情况等选择适合的手术方式，让患者更多获益。

Abstract:

Objective To summarize and analyze the clinical features of otogenic brain abscess and explore the treatment strategy. Methods A retrospective analysis was conducted on the clinical manifestations, auxiliary examinations and treatments, and follow-up of patients diagnosed with otogenic brain abscess who were hospitalized in the people’s hospital of Xinjiang Uygur Autonomous Region from January 2007 to December 2023. Results All 24 patients had a history of otitis media, 17 patients had headache symptoms. All patients underwent cranial CT scans, 19 of them completed cranial magnetic resonance imaging (MRI); There were 16 cases of temporal lobe abscess, 6 cases of cerebellar abscess, and 2 cases of both temporal lobe abscess and cerebellar abscess. The brain abscess of twelve cases was first excised or drained, and the patients were transferred to the department of otorhinolaryngology for middle ear mastoidectomy. Five cases of 24 patients first underwent radical mastoidectomy, and who was performed the resection or drainage of brain abscess in the second stage. One case was treated conservatively. The patients were followed up for 6 to 24 months after the operation.Twenty cases of 24 patients have been cured, two patients died, and two cases lost to follow-up. Conclusions Otogenic brain abscess usually occurs in cholesteatoma of the middle ear. Brain abscess should be considered when a patient has headache and CT of temporal bone indicate bone destruction in the middle cranial fossa and posterior cranial fossa. Adequate amount and full course of sensitive antibacterial drugs should be administered to the patients as soon as possible. The appropriate surgical Methods should be selected according to the location and size of the abscess, whether it is involved in functional areas, as well as the patient’s immune status, age, and systemic conditions.The measure is also aimed at benefiting patients.