摘要
目的 探讨儿童中耳胆脂瘤合并颅内并发症的临床特点和诊治要点.方法 回顾性选取2020年6月—2023年2月河南省儿童医院和首都医科大学附属北京儿童医院收治的3例儿童中耳胆脂瘤合并颅内并发症的病例资料,总结耳流脓、发热、头痛、呕吐、意识障碍等临床表现,以及治疗方式、多学科会诊、术中情况、治疗结局等特点.结果 3例患者中,男1例,女2例,均有耳流脓病史,伴有发热、头痛,其中1例出现喷射性呕吐、意识障碍等颅内压增高的表现.3例患者入院时均完善头颅CT及MRI、颞骨CT,2例合并硬脑膜外脓肿,1例合并小脑脓肿.入院后均经验性应用广谱抗菌药物治疗.3例患者均进行多学科会诊,制定围手术期方案,首先解决患儿高热、头痛、喷射性呕吐、意识障碍等急症,在颅内症状控制后与神经外科医师联合在全身麻醉下行根治性手术,并根据细菌培养及药敏试验改用敏感抗菌药物治疗,3例患者均治愈出院,术后随访无复发.结论 对儿童中耳胆脂瘤患者,当出现高热、头痛时,一定要警惕颅内并发症的出现,及时行头颅CT及MRI,并与多学科协作进行围手术期管理,在患者病情稳定后给予根治性乳突开放术,清除病变,通畅引流,以达到安全治愈的目的.
Abstract
Objective This paper focuses on clinical characteristics and key factors in diagnosis and treatment of middle ear cholesteatoma with intracranial complications in children.Methods Three cases of middle ear cholesteato-ma with intracranial complications treated at Henan Children's Hospital and Beijing Children's Hospital,Capital Medi-cal University,from June 2020 to February 2023 were reported,including clinical manifestations,treatment methods and outcomes.Results The cases included 1 boy and 2 girls.Clinical presentation included ear discharge and signs of meningitis with fever and headaches.One patient experienced severe mental state changes with projectile vomiting.Head CT and MRI,as well as temporal bone CT,revealed epidural abscess in 2 cases and cerebellar abscess in 1 case.Empiric antibiotics,multidisciplinary consultation and management of high fever,headaches,vomiting and conscious-ness changes were implemented while the individualized perioperative plan was developed.Radical mastoidectomy was performed under general anesthesia facilitated by a neurosurgeon for intracranial lesions,followed by targeted antibiot-ics based on culture and drug sensitivity test.Complete recovery was achieved in all three patients with no recurrence during follow-ups.Conclusion Intracranial complications should be suspected in children with middle ear cholesteato-ma showing high fever and headaches.Timely head CT and MRI evaluation and multidisciplinary consultation can facil-itate perioperative management.Canal wall-down mastoidectomy for lesion removal and unobstructed drainage is the treatment of choice once the patient is stabilized.
基金项目
北京市医院管理局儿科学科协同发展中心专项(XTYB201828)
国家区域医疗中心开放课题(NRMC0105)
国家科技期刊平台
NSTL
万方数据