中耳乳突术后并发严重感染的分析及临床处理  

Analysis and clinical management of severe infection after tympanoplasty and mastoidectomy

作　　者：鲁兆毅[1] 熊欣潞 潘滔[1] LU Zhaoyi;XIONG Xinlu;PAN Tao(Department of Otolaryngology Head and Neck Surgery,Peking University Third Hospital,Beijing,100191,China;Department of Otolaryngology,the First People's Hospital of Guiyang,Guiyang,Guizhou,550002,China)

机构地区：[1]北京大学第三医院耳鼻咽喉头颈外科,北京100191 [2]贵阳市第一人民医院耳鼻咽喉科,贵州贵阳550002

出　　处：《中国耳鼻咽喉头颈外科》2022年第1期30-32,36,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的研究中耳乳突手术后出现严重感染病例的临床表现及处理,分析其发生病因、临床特点及处理策略,为中耳乳突术后严重感染的预防及治疗提供参考。方法回顾性分析2019年1~12月在北京大学第三医院耳鼻咽喉头颈外科行中耳乳突手术、术后并发严重感染病例的临床资料。结果在238例中耳乳突手术病例中,3例出现严重感染,占比为1.26%,其中包括切口及术腔深部感染2例,并发化脓性耳廓软骨膜炎1例。临床表现包括早期耳痛,术区红肿、渗出,甚至软骨液化坏死等。经病原微生物培养,更换敏感抗生素、切开引流、病变组织清创以及充分换药等处理措施后,上述病例均痊愈,治疗时间2周~4个月,其中1例遗留严重听力下降,1例遗留耳廓畸形。结论中耳乳突手术后并发严重感染的发生率低,临床表现多样,治疗措施复杂。术后注意观察,早期发现,早期干预是避免感染后严重并发症的关键。OBJECTIVE To study the clinical manifestations and management of severe infection after tympanoplasty and mastoidectomy,analyze the etiology,clinical characteristics and treatment strategies,in order to provide reference for the prevention and management of severe infection after tympanoplasty and mastoidectomy.METHODSThe clinical data of patients with severe infection after tympanoplasty and mastoidectomy in Department of Otolaryngology,Peking University Third Hospital from January 2019 to December 2019 were retrospectively analyzed.RESULTS Among 238 cases of tympanoplasty and mastoidectomy,3 cases had severe infection,accounting for 1.26%.There were 2 cases with deep infection of incision and operation area,and 1 case withauricular suppurative perichondritis.The clinical manifestations included early postoperative otalgia,swelling,tenderness andexudation in operation area,and even liquefaction and necrosis of cartilage.After multiplemanagement including pathogen culture,sensitive antibiotics applying,incision and drainage,debridement of diseased tissue and sufficient dressing change,all the above cases were cured.The treatment lasted from 2 weeks to 4 months.One case residual with severe hearing loss,and 1 with auricle deformity.CONCLUSION The incidenceof severe infection after tympanoplasty and mastoidectomy is low.The clinical manifestations are various,and the treatment measures are complex.Post-operative observation,early detection and early intervention are the key to avoid serious complications after infection.

关 键 词：鼓室成形术 乳突 感染 假单胞菌 铜绿 耳廓 乳突开放术 耳廓化脓性软骨膜炎 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]