眼眶异物合并的头面部多发伤联合手术的思考  

Thinking of combined operation for orbital foreign body coexisted with the multiple craniofacial injury

作　　者：秦廷玉[1] 王文战[1] 吕勇[1] 朱丽娟[1] 杜伟[1] 陈若琨[1] 高莎莎[1] 

机构地区：[1]郑州大学第一附属医院眼科,450052

出　　处：《中华眼外伤职业眼病杂志》2015年第12期898-902,共5页Chinese Journal of Ocular Trauma and Occupational Eye Disease

基　　金：河南省医学科技攻关计划普通项目（编号：2014030551)

摘　　要：目的探讨眼眶异物损伤头面部其他部位时联合手术的必要性。方法2014年10月至2015年6月本治疗组急诊救治的巨大眼眶异物合并的头面部多发伤患者4例，其中2例伤及脑组织。总结临床表现、影像学征象和手术后3d的治疗效果。所有患者在全身麻醉下接受异物摘出术，均经一次手术摘出全部异物及清除周围腐烂组织。结果2例眼眶异物多发伤伤及脑组织者进行眼科和神经外科的联合手术，且以神经外科开颅摘出异物手术为主；另2例眼眶异物多发伤未伤及脑组织者单纯实施眼科手术，即眼眶异物摘出术。术后3d伤口愈合良好，症状改善，未见与手术相关的严重并发症。结论眼眶异物合并的头面部多发伤病情复杂，处置不当易导致异物残留或引起并发症，严重时危及视力或生命。因此正确分析病史及临床表现，及时多学科会诊和手术，彻底摘出异物，在处理这类外伤时是必不可少的。Objective To investigate the necessity of combined operation for orbital foreign body coexisted with the multiple craniofacial injury. Methods Four cases with large orbital foreign bodies coexisted with the multiple craniofacial injury including 2 cases with brain injury were collected in this study from October 2014 to June 2015. Then the clinical manifestations, imaging features and treatment effect at 3 days after the surgery were summarized. All patients underwent foreign body extraction surgery under general anesthesia, and all the foreign bodies and the surrounding rotten tissue were removed thoroughly by one single operation. Results The orbital foreign body injury with eraniocerebral injury （2 cases） underwent the joint operation of ophthalmology and neurosurgery. The orbital foreign body injury without craniocerebral injury （2 cases） only underwent opbthalmologic surgery. The wound healed well at 3 days after the surgery, the symptom improved, and the complication associated with the surgery did not occur. Conclusion The condition of orbital foreign body coexisted with the multiple craniofacial injury is complicated. If the foreign body is not disposed properly, it is easy to cause the residue or complication. Severely, it can threaten vision or even life. Therefore, the managements, such as understanding medical history and clinical manifestations correctly, undergoing multidisciplinary consultation and surgery timely, and extracting foreign bodies completely, in dealing with this kind of trauma are essential.

关 键 词：异物 外伤 眼眶 头面部 脑组织 处理 多学科 联合手术 

分 类 号：R779.1[医药卫生—眼科] R651.1[医药卫生—临床医学]