耳源性脑脓肿105例临床分析

目的 本文的目的为探讨耳源性脑脓肿的发生、诊断和治疗。方法 对1952～2002年治疗的105例耳源性脑脓肿患者(颞叶66例,小脑38例),对疾病的发生、诊断和治疗方式进行回顾性分析,特别是手术所见、诊断方法、治疗方法和结果。结果本组中发病年龄主要在10～30岁,10岁以内和更高的年龄组较少见。头痛(99.05％)、淡漠和昏迷(91.43％)是较常见的症状。105例中神经系统检查异常者78例。23例经CT诊断。经乳突腔穿刺抽脓者63例,外科钻颅穿刺抽脓26例,脓肿切除17例。死亡15例,其中66例颞叶脓肿中11例死亡,38例小脑脓肿中3例,脓肿部位不明者1例。结论 正确掌握经乳突腔穿刺抽脓的适应证对耳源性脑脓肿的治疗十分重要。颅骨钻孔穿刺引流和脑室引流是脑疝的有效的紧急处理措施。自CT用于耳源性脑脓肿的诊断和随访以来,死亡率明显下降。

Clinical Analysis of 105 Cases of Otogenic Brain Abscess

[Objective] The aim of the study was to investigate the development, diagnostic methods and treatment of otogenic brain abscesses. [Methods] The retrospective study covered 105 patients with otogenic brain abscess (66 temporal lobe and 38 cerebellar) treated from 1952 to 2002. Medical records of the studied patients were analyzed for the occurrence of the disease, diagnosis and mode of therapy. Special care was dedicated to type of otitis, surgical findings, diagnostic methods, mode of therapy and therapy outcome. [Results] In our group of patients otogenic brain abscesses were most common in the second and third decade of life, than in the first, while the frequency of the complication fell significantly in older age groups . Headache (99. 05%) , apathia and coma (91.43%) were the most common symptoms. Neurological examination of 105 patients with cerebral abscess evidenced the abscess in 78(44 temporal lobe and 33 cerebellar). The diagnosis of abscess was established by computerized tomography in 23 patients. Sixty - three cases treated with evacuation of the abscess through the mastoidectomy , burr hole drainage was performed in 26 our patients, and in 17 patients need the surgical remove of the abscesses with craniotomy . Out of 66 patients with temporal lobe abscess 11 died while 3 patients died out of 38 patients with cerebellar abscess , and the location unknown in one died patient. [ Conclusion] It was very important to hold the indications of evacuation of the abscess through the mastoidectomy . Burr hole drainage and evacuation of encephalocoele were the effective methods to save the patients when hernia of brain occurred. When CT became available for the diagnosis and follow- up, the mortality rate was reduced .