摘要目的 探讨影像导航辅助下耳源性脑脓肿穿刺引流术的操作技术及疗效.方法 回顾性分析2010年5月至2013年10月4例在影像导航辅助下行穿刺引流术的耳源性脑脓肿患者的临床资料.4例患者均为男性,年龄21 ～59岁,其中25岁以下者3例.均有中耳胆脂瘤病史,脑脓肿均为单发,其中大脑颞叶脓肿3例,小脑脓肿1例.结果 3例颞叶脓肿患者采用颅骨钻孑孔穿刺引流术,1例小脑脓肿患者采用乳突腔穿刺引流术.4例患者在影像导航辅助下均一次穿刺成功,抽出脓液6～15 ml不等.患者病情稳定、影像学显示脓腔闭合后,行乳突中耳手术彻底清除胆脂瘤病灶.穿刺脓液细菌培养3例有细菌生长,包括金黄色葡萄球菌、缓症链球菌、变形杆菌各1例.4例患者均痊愈,无并发症.术后随访1年,乳突腔上皮化良好.结论 影像导航辅助下脑脓肿穿刺引流术具有定位准确、创伤小、手术时间短、安全性高等特点,可根据患者病情需要酌情选择.

abstractsObjective To investigate the methods and results of imaging guided puncture and drainage in the treatment of otogenic brain abscess.Methods Reviewed and analyzed four cases of otogenic brain abscess treated by the technique of imaging guided puncture and drainage from May 2010 to October 2013, all of the four cases were male with age ranged from 21 years old to 59 years old, among whom three cases were under 25 years old.All patients had history of middle ear cholesteatoma and were found single brain abscess.Three cases were cerebrum abscess and one case was cerebellum abscess.Results The three cases with temporal lobe abscess received skull puncture drainage drilling, and one case with cerebellar abscess used the mastoid cavity puncture drainage.Four cases were punctured successfully in one time with the assistance of image navigation, 6-15 ml of pus was drainged out.After imaging showed pus cavity closure, middle ear surgery was performed to thoroughly remove cholesteatoma.The pus bacteria was cultured, which found three cases infected with staphylococcus aureus, Streptococcus mitis and proteusbacillus vulgaris respectively.The imaging showed brain abscess closed after once puncture drainage,four cases were cured without complications.Postoperative follow-up of one year with good mastoid cavity epithelialization.Conclusion Image guidance assisted puncture can drainage brain abscess with accurate positioning, less trauma, short operation time, and high safety, which could be choosen for otogenic abscess patient.