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首页> 外文期刊>The Laryngoscope: A Medical Journal for Clinical and Research Contributions in Otolaryngology, Head and Neck Medicine and Surgery, Facial Plastic and Reconstructive Surgery .. >Otogenic sigmoid sinus thrombosis: what is the role of anticoagulation?
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Otogenic sigmoid sinus thrombosis: what is the role of anticoagulation?

机译：耳源乙状窦窦血栓形成：抗凝作用是什么？

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OBJECTIVES The treatment of otogenic sigmoid sinus thrombosis with surgery and antibiotics is well established. However, the role of anticoagulation remains unstudied. The study reviews the signs, symptoms, radiological evaluation, surgical treatment, and medical management of patients with otogenic sigmoid sinus thrombosis treated with or without anticoagulation.STUDY DESIGN Retrospective review of nine patients from 1995 to 2001 with sigmoid sinus thrombosis.METHODS Patients were identified by a review of all medical and radiological records. Signs, symptoms, diagnostic studies, treatments, and outcomes were recorded. In addition, telephone follow-up was performed.RESULTS Nine patients were identified over a 6-year period from 1995 to 2001. Patients had a mean follow-up time of 9 months (range, 1-24 mo). Of the nine patients identified, eight patients (89%) had tympanostomy tube placement, six patients (67%) had canal wall intact mastoidectomy, and one patient (11%) had canal wall down mastoidectomy. Needle aspiration of the sinus was performed in four of nine patients (44%), and incision of the sinus in two of nine (22%). Treatment with broad-spectrum antibiotics occurred in all patients with a mean duration of 12 days (range, 2-22 d) intravenously and 7 days (range, 0-21 d) orally. Sixty-seven percent of patients (six of nine) were anticoagulated: Five patients received low-molecular-weight heparin, and one patient received heparin-coumadin. No mortality occurred in either the anticoagulated or non-anticoagulated group. One anticoagulated patient did have persistent headaches and otorrhea.CONCLUSIONS Surgery and antibiotic therapy are the cornerstones of the management of otogenic sigmoid sinus thrombosis. However, the role of anticoagulation remains unclear. Because complications of embolization and persistent sepsis are low in otogenic sigmoid sinus thrombosis patients treated with or without anticoagulation, withholding anticoagulation in selected patients is reasonable. Serial imaging to monitor for thrombus progression is advisable.
机译：目的通过外科手术和抗生素治疗耳源性乙状窦窦血栓形成是公认的。然而，抗凝作用的作用仍未研究。研究回顾了1995年至2001年间9例乙状窦血栓形成患者的体征，症状，影像学评估，外科治疗和药物治疗的原发性乙状窦血栓形成患者的回顾性研究。通过审查所有医疗和放射学记录。记录体征，症状，诊断研究，治疗和结果。结果，从1995年至2001年的6年中，确定了9例患者。平均随访时间为9个月（范围1-24 mo）。在确定的9例患者中，有8例（89％）进行了鼓室造瘘管置入，6例（67％）进行了乳腺管壁完整乳突切除术，其中1例（11％）进行了乳腺管壁下乳突切除术。九名患者中有四名（44％）进行了鼻窦针抽吸，九名患者中有两名（22％）进行了鼻窦切开术。所有患者均进行了广谱抗生素治疗，静脉内平均时间为12天（2-22天），口服7天（0-21天）。 67％的患者（九分之六）接受了抗凝治疗：5例患者接受了低分子量肝素，1例患者接受了肝素-香豆素。抗凝或非抗凝组均无死亡发生。一名抗凝患者确实患有持续性头痛和耳漏。结论外科手术和抗生素治疗是控制耳源性乙状窦窦血栓形成的基础。但是，抗凝作用尚不清楚。由于接受或不接受抗凝治疗的耳源性乙状窦血栓形成患者栓塞和持续性败血症的并发症发生率低，因此在某些患者中选择抗凝治疗是合理的。建议进行串行成像以监测血栓的进展。

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