扁桃体周围脓肿切开术后引发颅内积气1例并文献复习

doi:10.6040/j.issn.1673-3770.0.2022.458

摘要/Abstract

摘要： 目的探讨扁桃体周围脓肿切开术后引发颅内积气的临床表现、潜在机制、诊断、治疗及预后,为耳鼻喉科医生提供临床借鉴和参考。方法回顾性分析1例扁桃体周围脓肿切开术后出现颅内积气患者的临床资料并复习相关文献。结果早期颅内积气缺乏特异性,当病情进展出现大量积气时会出现头痛、呕吐等症状,严重时危及生命。其病因复杂多样,但在没有颅脑损伤的情况下发生自发性颅内积气者罕见。结合影像学检查,考虑患者颅内积气的原因可能为手术切开过程中外界气体进入咽旁间隙并在此蓄积,伴随压力升高,诱发“球阀”机制,气体沿颈内静脉周围的潜在腔隙由颈静脉孔入颅。结论扁周脓肿切开引流术后发生有症状的颅内积气罕见。早期症状无特异性,容易被忽视。因而,耳鼻喉科医生应注意扁周脓肿术后可能出现颅脑积气,可以结合影像学检查进行早期诊断和早期治疗,避免发生严重的颅内并发症。

关键词: 扁桃体周围脓肿, 咽旁间隙感染, 颅内积气, 颈静脉孔, 早期诊治

Abstract: Objective To provide clinical references to otolaryngologists by investigating the clinical manifestations, underlying mechanisms, diagnosis, treatment, and prognosis of intracranial pneumatosis secondary to peritonsillar abscess incision. Methods We reviewed the relevant literature and retrospectively analyzed the clinical data of a patient with intracranial pneumatosis who underwent incisional drainage for a peritonsillar abscess in our hospital. Results The patient was almost asymptomatic in the early stage. As the disease progressed and gas accumulation increased, the patient presented with headaches and vomiting. According to the literature, intracranial pneumatosis can be life-threatening. Intracranial pneumatosis can be caused by various factors. However, it rarely arises spontaneously, without a history of cranial injury. Based on imaging findings, we suspect that in our patient, the intracranial pneumatosis was caused by external gases that entered the parapharyngeal space during surgical incision. As gases accumulate, a pressure difference is generated, and a “ball-valve” effect is induced. The gas is forced upward along the lumen surrounding the internal jugular vein and enters the skull through the jugular foramen. Conclusion Symptomatic intracranial pneumatosis due to a peritonsillar abscess incisional drainage is rare. It may be readily overlooked as the early symptoms are nonspecific. To optimize patient prognosis, otolaryngologists should be aware of the possibility of such complications and consider imaging examinations for early diagnosis and treatment.

Key words: Peritonsillar abscess, Intracranial pneumatosis, Parapharyngeal space, Jugular foramen, Early diagnosis

中图分类号:

R766.18

徐聪,卢国伟,吕永斌,刘大炜,宋西成,孙岩. 扁桃体周围脓肿切开术后引发颅内积气1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2023, 37(5): 63-67.

XU Cong, LU Guowei, LÜ Yongbin, LIU Dawei, SONG Xicheng, SUN Yan. Intracranial pneumatosis caused by peritonsillar abscess incisional drainage: a case report and literature review[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(5): 63-67.

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