儿童耳源性乙状窦血栓性静脉炎3例诊治分析  

Diagnosis and treatment of otogenic sigmoid sinus thrombophlebitis in children

作　　者：刘畅 陆颖霞[1] 吴朔春[2] 王梦[1] 占小俊 谷庆隆[1] Liu Chang;Lu Yingxia;Wu Shuochun;Wang Meng;Zhan Xiaojun;Gu Qinglong(Department of Otorhinolaryngology Head and Neck Surgery,Children′s Hospital affiliated to Capital Institute of Pediatrics,Beijing 100020,China;Department of Radiology,Children′s Hospital affiliated to Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院耳鼻咽喉头颈外科,北京100020 [2]首都儿科研究所附属儿童医院影像科,北京100020

出　　处：《中华预防医学杂志》2025年第3期406-410,共5页Chinese Journal of Preventive Medicine

基　　金：北京市自然科学基金资助(7232010)。

摘　　要：乙状窦血栓性静脉炎(SST)作为儿童耳源性感染的危重并发症,其早期诊断及治疗对改善预后至关重要。本研究报道了3例(年龄2岁9个月至4岁)经影像学确诊的耳源性SST患儿,均继发于急性中耳炎。临床特征主要表现为反复高热、耳痛、耳后肿胀,其中1例合并展神经麻痹及耳流脓。影像学特征显示:颞骨高分辨率CT显示乙状窦前壁骨质破坏;耳部磁共振特征性表现为乙状窦区T2WI高信号、增强后环形强化及DWI弥散受限;耳部磁共振静脉造影可清晰显示静脉窦血栓累及范围。治疗采用手术开放引流联合敏感抗生素及抗凝治疗的综合方案,所有患儿均获临床治愈。通过文献回顾发现,儿童SST起病隐匿,当耳部感染患者出现“中耳炎三联征”(发热、耳痛、头痛)伴神经系统症状时需高度警惕。影像学检查对于早期诊断至关重要,规范化治疗(感染灶清除和足疗程抗感染抗凝)可显著改善预后,为儿童SST的临床管理提供参考依据。Sigmoid sinus thrombophlebitis(SST)as a severe complication of otogenic infections in children,its early diagnosis and treatment are crucial for improving prognosis.This study reports three cases(aged 2 years,9 months to 4 years)of otogenic SST in children diagnosed by imaging,all secondary to acute otitis media.The clinical features mainly included recurrent high fever,ear pain,and postauricular swelling,with one case complicated by abducens nerve palsy and otorrhea.Imaging characteristics revealed:HRCT of the temporal bone showed destruction of the anterior wall of the sigmoid sinus;characteristic MRI findings of the ear included high T2WI signal in the sigmoid sinus area,ring enhancement post-contrast,and restricted diffusion on DWI;MRV of the ear clearly displayed the extent of venous sinus thrombosis.Treatment involved a comprehensive approach of surgical drainage combined with sensitive antibiotics and anticoagulant therapy,and all children achieved clinical cure.Through literature review,it was found that SST in children has an insidious onset,and high vigilance is required when otogenic infection patients present with the"otitis media triad"(fever,ear pain,headache)accompanied by neurological symptoms.Imaging examination is crucial for early diagnosis,and standardized treatment(clearance of infection foci and adequate course of anti-infection and anticoagulation)can significantly improve prognosis,providing a reference for the clinical management of SST in children.

关 键 词：乙状窦血栓性静脉炎 中耳炎 儿童 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]