成人自发性脑脊液耳漏4例临床分析并文献复习  

Adult Spontaneous Cerebrospinal Fluid Otorrhea:A Report of 4 Cases with Literature Review

作　　者：耿猛 姜媛 张思琪 蒋新霞[1] 杜希同 王建涛[1] 朱庆文[1] GENG Meng;JIANG Yuan;ZHANG Siqi;JIANG Xinxia;DU Xitong;WANG Jiantao;ZHU Qingwen(Department of Otolaryngology Head&Neck Surgery,Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院耳鼻咽喉头颈外科,石家庄050000

出　　处：《中华耳科学杂志》2024年第4期627-631,共5页Chinese Journal of Otology

摘　　要：目的探讨成人自发性脑脊液耳漏(spontaneous cerebral spinal fluid otorrhea,SCSFO)的临床特点及治疗。方法回顾性分析2015年6月至2022年6月河北医科大学第二医院耳鼻咽喉头颈外科收治的4例成人SCSFO患者的临床病例资料。4例患者术前均曾被误诊为分泌性中耳炎;病例1和病例3漏口位置在乳突盖,病例4漏口位置在鼓室盖,3例均采用经乳突入路的手术方式;病例2漏口位置在鼓室盖,采用乳突切除+腹部脂肪填塞耳道封闭术。结果3例患者经手术治疗取得满意效果,病例4术后仍有耳漏,行保守治疗后耳漏消失,所有病例随访6月~7年6月,平均随访时间4年3月,均未复发。结论成人SCSFO临床罕见,易被误诊为分泌性中耳炎,颞骨高分辨率CT(high resolution CT,HRCT)和核磁共振(magnetic resonance imaging,MRI)对于诊断和漏口部位的判断及手术方式的选择具有重要价值和意义。Objective To report clinical features and treatment of adult spontaneous cerebrospinal fluid otorrhea.Methods Clinical data of 4 patients suffering from spontaneous cerebrospinal fluid otorrhea surgically treated in our department between June 2015 and June 2022 were retrospectively analyzed.All 4 cases were misdiagnosed as secretory otitis media.Defects were located to the tegmen mastoideum in cases 1 and 3,and to the tegmen tympani in cases 4,all surgically repaired through the transmastoid approach.Defect was located in the tegmen tympani in case 2 with brain tissue prolapsed to the tympanum,partly wrapping the ossicles and repaired by mastoidectomy plus adipose tissue packing.Results Satisfactory results were achieved after primary repair in cases 1 and 3.Otorrhea initially persisted after primary repair in case 4 but resolved with conservative treatments.No recurrence occurred during followed ups(6 months to 7 years and 6 months,average=4 years and 3 months).Conclusion Pre-operative temporal bone HRCT and MRI scans for diagnosis are important to ensure accurate location of leakage site and appropriate surgical planning.

关 键 词：脑脊液耳漏 自发性 颅底缺损 治疗 

分 类 号：R764[医药卫生—耳鼻咽喉科]