22例儿童急性化脓性中耳炎并发耳后骨膜下脓肿的临床分析  

Clinical analysis of 22 cases of acute suppurative otitis media complicating postauricular subperiosteal abscess in children

作　　者：司淑瑞 张志强 金香花 崔哲洙 Si Shurui;Zhang Zhiqiang;Jin Xianghua;Cui Zhezhu(Department of Otorhinolaryngology Head and Neck Surgery,Yanbian University Hospital,Yanji 133000,China)

机构地区：[1]延边大学附属医院(延边医院)耳鼻咽喉头颈外科,延吉133000

出　　处：《国际耳鼻咽喉头颈外科杂志》2024年第5期249-252,共4页International Journal of Otolaryngology-Head and Neck Surgery

摘　　要：目的探讨儿童急性化脓性中耳炎导致的耳后骨膜下脓肿的临床特点与治疗方法。方法回顾性分析2010年3月至2023年1月延边大学附属医院(延边医院)耳鼻咽喉头颈外科收治的22例耳后骨膜下脓肿患儿的临床资料,探讨其发病原因、细菌检出率、细菌分类、中耳解剖学特点、临床特点及治疗方案。结果所有患儿发病前均有急性上呼吸道感染史。症状较重的16例患儿行耳后脓肿切除术+完壁式乳突切开术+上鼓室成形术,而症状相对轻的6例患儿行抗生素+脓肿穿刺等保守治疗。手术治疗患儿,取术区脓液或带脓液组织的细菌培养检出率为81.3%(13/16),保守治疗患儿,抽取耳后脓液的细菌培养检出率为33.3%(3/6)。细菌培养结果,主要致病菌为肺炎链球菌14例,变形杆菌1例,化脓性链球菌1例,未检出细菌6例。所有患儿均为气化型乳突,且鼓室盖抬高及鼓室盖完整,2例乙状窦破坏,2例面神经管破坏。结论耳后骨膜下脓肿继发于急性化脓性中耳炎,主要致病菌为肺炎链球菌。好发于气化型乳突并鼓室盖抬高者,大部分患儿鼓室盖完整。症状较重者行耳后脓肿切开+完壁式乳突切开术+上鼓室开放术,而症状较轻者可采用保守治疗。Objective To investigate the clinical characteristics and treatment of posterior subperiosteal abscess caused by acute suppurative otitis media in children.Methods The clinical data of 22 children with retroauricular subperiosteal abscess treated with surgery and conservative treatment from March 2010 to January 2023 were retrospectively analyzed.The causes,bacterial detection rate,bacterial classification,anatomic characteristics of middle ear,clinical characteristics and treatment plan were discussed.Results There was history of acute upper respiratory tract infection in all the children before the onset of the disease.Sixteen children with severe symptoms underwent postauricular abscess resection+intact canal wall mastoidectomy+superior tympanoplasty,while six children with relatively mild symptoms underwent conservative treatment with antibiotics+abscess puncture.The bacterial culture detection rate of pus or tissue with pus in the operative area was 81.3%(13/16)in 16 children undergoing surgical treatment,and 33.3%(3/6)in 6 children undergoing conservative treatment.The main pathogenic bacteria were streptococcus pneumoniae in 14 cases,bacillus proteus in 1 case,streptococcus pyogenes in 1 case,and no bacteria were detected in 6 cases.Conclusions Subtympanic abscess is secondary to acute suppurative otitis media.The main pathogen is Streptococcus pneumoniae.Pneumatized mastoid are found in all children with elevated tympanic cover,most of them have intact tympanic cover.Postauricular abscess incision and complete wall mastidectomy and upper tympanectomy are performed in children with more severe symptoms,while conservative treatment can be used in children with milder symptom.

关 键 词：中耳炎 化脓性 外科手术 耳后骨膜下脓肿 完壁式乳突切开术 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]