鼻窦炎伴眶骨膜下脓肿治疗方式的选择  

Treatment Choice for Patients with Sinusitis Complicated with Subperiosteal Abscess

作　　者：龙小博[1] 王慧[2] 陈金[1] 王恒[1] 刘争[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院耳鼻咽喉-头颈外科,武汉430030 [2]湖北省妇幼保健院耳鼻喉科,武汉430070

出　　处：《华中科技大学学报（医学版）》2017年第2期190-194,200,共6页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：国家自然科学基金资助项目(No.81400448)

摘　　要：目的探讨鼻窦炎伴眶并发症的临床表现、诊疗过程及治疗效果,特别对鼻窦炎合并眶骨膜下脓肿(ChandlerⅢ期)治疗方式的选择进行探讨。方法对随访资料完整的33例鼻窦炎伴眶并发症病例进行回顾性分析,并着重分析鼻窦炎伴眶骨膜下脓肿患者中单纯保守治疗患者(保守治疗组)和保守治疗无效后行手术治疗患者(保守治疗+手术治疗组)之间临床表现差异。结果鼻窦炎伴眶并发症患者共33例按Chandler分期包括:Ⅰ期5例,Ⅱ期11例,Ⅲ期16例,Ⅳ期1例,其中Ⅰ期、Ⅱ期、Ⅲ期保守治疗有效率分别为20.0%、27.3%和31.3%。Ⅲ期患者中保守治疗+手术治疗组患者治疗前眼部体征包括眼突>4mm、视力下降、眼球运动障碍、复视和眼压升高的发生率均高于保守治疗组患者,差异具有统计学意义;保守治疗组患者治疗前眶骨膜下脓肿在CT上测得的长、宽、高径均小于保守治疗+手术治疗组患者,差异具有统计学意义。33例患者经治疗后除2例患者视力未恢复外,其余症状均有不同程度改善,随访6个月以上均未复发。结论鼻窦炎伴眶并发症Ⅰ期、Ⅱ期可先给予以抗生素为主的保守治疗48h,症状无缓解者应及时行手术治疗;Ⅲ期成人患者若未出现眼突>4mm、视力下降、眼球运动障碍、复视、眼压>21mmHg和脓肿高径>0.50cm等临床表现时也可先行保守治疗,并严密观察48h,若保守治疗无效应及时行手术治疗;Ⅳ期患者首选急诊手术治疗。Objective To investigate the clinical features, diagnosis and treatment of sinusitis with orbital complications and the indications for surgical treatment of sinusitis with subperiosteal abscess（Chandler Ⅲ）. Methods In this retrospective stud y,33 patients with sinusitis and orbital complications were enrolled and the clinical characteristics and treatment outcomes of these patients were examined. Especially, the differences in clinical manifestations were analyzed between patients who under went conservative treatment and surgical treatment after failure of conservative treatment. Results Thirty-three patients were grouped according to the Chandler stage system=5 cases in stage Ⅰ ,Ⅱ cases in stage Ⅱ ,16 cases in stage Ⅲ and 1 case in stage IV. The effective rates of conservative treatment for patients in stage Ⅰ,stageⅡ and stage Ⅲ were 20.0% ,27.3% and 31.3$, respectively. Patients in stage Ⅲ were more likely to have proptosis（2〉 4 mm）, decreased vision,ophthalmoplegia, diplopia and elevated intraocular pressure in conservative plus surgical treatment group than in conservative treatment group. For patients in stage Ⅲ, the length,width and height of subperiosteal abscess measured on the CT image were significantly less in conservative treatment group than in conservative plus surgical treatment group. All patients recovered well except two patients with im paired visual acuity. No patients relapsed in 6-month follow-up. Conclusion For patients with sinusitis and orbit complications in stage I and lI ,conservative treatment could be tried for the first 48 h. Surgery should be performed if the conservative treat ment is not effective. The conservative treatment could first be attempted in adult patients at stage Ⅲ who have no manifesta tions of proptosis（〉 4 mm）, decreased vision, ophthalmoplegia, diplopia, elevated intraocular pressure, or abscess height 2〉 0.50 cm on CT images. During 48 h surveillance,surgery should be performed quickly for those who have no improvement o

关 键 词：鼻窦炎 眶并发症 眶骨膜下脓肿 鼻内镜手术 

分 类 号：R765.51[医药卫生—耳鼻咽喉科]