11例急性鼻窦炎并发眶骨膜下脓肿的诊治分析

曹媛; 宋晴; 张田; 柳忠禄; 孙岩; 毛宁; 王洪波; 陈秀梅; 宋西成

doi:10.13201/j.issn.2096-7993.2021.02.008

11例急性鼻窦炎并发眶骨膜下脓肿的诊治分析

- 1.
  青岛大学附属烟台毓璜顶医院耳鼻咽喉头颈外科(山东烟台，264000)
- 2.
  潍坊医学院临床医学院
- 3.
  青岛大学附属烟台毓璜顶医院影像科

详细信息

通讯作者: 宋西成，E-mail：songxicheng@126.com

中图分类号: R765.4

收稿日期: 2020-07-13

刊出日期: 2021-02-05

Diagnosis and treatment of 11 cases of subperiosteal orbital abscess caused by acute sinusitis

- 1.
  Department of Otorhinolaryngology Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, 264000, China
- 2.
  Weifang Medical University, Clinical Medical College
- 3.
  Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University

More Information

Corresponding author: SONG Xicheng, E-mail: songxicheng@126.com

Received Date: 13 July 2020

Publish Date: 05 February 2021

摘要

摘要: 目的总结急性鼻窦炎并发眶骨膜下脓肿的诊断、临床表现及手术治疗经验。方法回顾性分析11例1岁8个月~50岁急性鼻窦炎并发眶骨膜下脓肿患者的临床资料, 包括临床表现、影像学表现、细菌学检验、手术方式及治疗效果。所有患者均给予抗菌药物、糖皮质激素以及手术治疗。结果 11例患者均为单侧病变, 影像学检查均支持眶骨膜下脓肿表现, 9例患者行鼻内镜下鼻窦开放+眶骨膜下脓肿切开引流术, 2例行鼻内镜下鼻窦开放+超声引导下脓肿穿刺术。均痊愈出院, 出院时眼睑肿胀、突眼症状基本缓解, 10例患者未出现视力改变; 1例患者就诊时视力仅存光感, 出院时恢复至0.05, 随访3个月视力无变化。鼻腔分泌物或脓液细菌培养阳性者7例, 分别为金黄色葡萄球菌3例(其中1例为耐甲氧西林金黄色葡萄球菌)、咽峡炎链球菌2例、中间链球菌2例。结论鼻源性眶骨膜下脓肿起病急, 进展快, 一旦形成脓肿, 保守治疗效果欠佳者需尽早选择手术治疗。手术方式最常见的是鼻内镜下鼻窦开放+眶骨膜下脓肿切开引流术, 若脓肿位于眼球上方或者外上方, 需结合超声引导下穿刺或切开引流。
- 鼻窦炎 /
- 眶脓肿 /
- 内镜外科手术
Abstract: Objective The aim of this study is to explore the diagnosis, clinical manifestations and surgical treatment experience of acute sinusitis complicated with orbital subperiosteal abscess.Methods The clinical data of 11 patients with acute sinusitis complicated by orbital subperiosteal abscess from 1 year and 8 months to 50 years were retrospectively analyzed, including clinical manifestations, imaging manifestations, bacteriological examinations, surgical methods and therapeutic effects. All patients were given antibacterial drugs, glucocorticoids, and surgery.Results All 11 patients had unilateral lesions. The imaging examinations all supported the appearance of orbital subperiosteal abscess. Nine patients underwent nasal endoscopic sinus opening+SPOA incision and drainage, 2 patients underwent nasal endoscopic sinus opening+ultrasound guided abscess puncture. Eyelid swelling and exophthalmia of all patients were alleviated when discharged. Ten of the 11 patients had no visual acuity change, and one patient had light perception only when she came to the hospital and recovered to 0.05 when discharged, there was no change in visual acuity after 3 months follow-up. The bacterial cultures of nasal secretion or pus were positive in 7 cases, the main pathogenic bacteria were Staphylococcus aureus(3 cases, includes one case of MRSA), Streptococcus anginosus(2 cases), and Streptococcus intermedius(2 cases).Conclusion Rhinogenous orbital subperiosteal abscess has a rapid onset and progresses quickly. Once an abscess is formed, patients with poor conservative treatment should choose surgical treatment as soon as possible. The most common surgical method is nasal endoscopic sinus opening+SPOA incision and drainage. If the abscess is located above or above the eyeball, puncture or incision and drainage should be combined with ultrasound guidance.
- sinusitis /
- orbital abscess /
- endoscopic surgical procedures

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图 1 术前鼻窦CT

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图 2 术后第3天眼部B超所示

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图 3 术后第6天鼻窦CT复查

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图 4 术前眼部情况

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图 5 术前鼻窦CT

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图 6 术后第2天鼻窦CT复查

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图 7 术后第3天鼻窦MRI

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图 8 术后第12天眼部MRI复查

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图 9 出院时眼部情况

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表 1 11例患者的临床症状、体征及手术方式

例序	年龄	性别	脓肿侧别	眼球突出	眼球活动	上睑下垂	视力下降	分泌物细菌培养结果	手术方式
1	2岁2个月	男	左	无	正常	无	无	咽峡炎链球菌	第1次：鼻内镜下左侧筛窦、上颌窦开放术+超声引导下眶骨膜下脓肿穿刺术；第2次：超声引导下脓肿穿刺术
2	8岁	女	右	有	受限	有	有	金黄色葡萄球菌	鼻内镜下右侧筛窦、上颌窦、蝶窦开放+眶减压+右侧眶骨膜下脓肿切开引流术
3	3岁11个月	男	左	有	受限	有	无	金黄色葡萄球菌	鼻内镜下左侧筛窦、上颌窦开放+眶减压+左侧眶骨膜下脓肿切开引流术
4	1岁8个月	男	右	有	正常	无	无	咽峡炎链球菌	鼻内镜下右侧筛窦、上颌窦开放+眶减压+右侧眶骨膜下脓肿切开引流术
5	6岁	男	左	无	正常	无	无	金黄色葡萄球菌	鼻内镜下左侧上颌窦、筛窦、蝶窦开放+眶减压+左侧眶骨膜下脓肿切开引流术
6	15岁	男	右	有	受限	无	无	无细菌生长	鼻内镜下右侧全组鼻窦开放+眶减压+右侧眶骨膜下脓肿切开引流术
7	16岁	女	右	有	受限	有	无	中间链球菌	鼻内镜下右侧筛窦、上颌窦、额窦开放+眶减压术+超声引导下眶骨膜下脓肿穿刺置管引流术
8	25岁	男	左	有	受限	有	无	无细菌生长	鼻内镜下左侧全组鼻窦开放+眶减压+左侧眶骨膜下脓肿切开引流术
9	26岁	男	左	有	受限	无	无	无细菌生长	鼻内镜下左侧筛窦、上颌窦、蝶窦开放+眶减压+左侧眶骨膜下脓肿切开引流术
10	50岁	女	左	有	受限	无	无	无细菌生长	鼻内镜下左侧筛窦开放+眶减压+左侧眶骨膜下脓肿切开引流术
11	5岁	女	右	有	受限	无	无	中间链球菌	鼻内镜下右侧筛窦、上颌窦开放+眶减压+右侧眶骨膜下脓肿切开引流术

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