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摘要: 目的 分析总结儿童急性鼻窦炎并发眶蜂窝织炎的临床特点及诊疗方法。方法 回顾性分析天津市儿童医院2016年4月—2021年3月收治的51例急性鼻窦炎并发眶蜂窝织炎患儿的临床资料，根据发病部位分为眶隔前蜂窝织炎组(7例)和眶隔后蜂窝织炎组(44例)，比较两组的临床表现、实验室检查结果及治疗情况。23例(眶隔前蜂窝织炎组6例，眶隔后蜂窝织炎组17例)患儿采用保守治疗; 28例(眶隔前蜂窝织炎组1例，眶隔后蜂窝织炎组27例)患儿在保守治疗无明显效果后采用手术治疗。结果 两组患儿的患病年龄、性别及病史时间无明显差异。眼睑红肿热痛是儿童眶隔蜂窝织炎最常见的临床表现，其次依次为发热、头痛、流涕、眼球固定及视力下降。眶隔后蜂窝织炎组患儿的白细胞计数和中性粒细胞百分比均高于眶隔前蜂窝织炎组，差异有统计学意义。所有患儿随访3个月~3年，1例失访，50例患儿无复发，恢复良好。结论 眶蜂窝织炎是儿童鼻窦炎常见并发展迅速的并发症，早期诊断、有效的抗感染治疗对预后十分重要。眼眶CT对该并发症的确定及病情评估有重要作用。保守治疗无效时及时通过外科手术可达到引流的目的，从而减少严重眼部并发症的发生。Abstract: Objective To analyze the clinical features, diagnosis and treatment of acute sinusitis related orbital cellulitis in children.Methods The data of 51 cases with acute sinusitis comorbid with orbital cellulitis in Tianjin Children's Hospital from April 2016 to March 2021 were retrospectively analyzed. According to the extent of infection, the patients were divided into two groups: pre-septal orbital cellulitis(7 cases) and post-septal orbital cellulitis(44 cases). The general clinical characteristics, clinical manifestations, laboratory examination and treatment were compared between the two groups. Among them, 23 cases(6 in pre-septal orbital cellulitis group and 17 in post-septal orbital cellulitis group) were cured by medicine treatment; 28 cases were cured by surgical treatment after failure of medicine treatment.Results There was no significant difference in age, gender and medical history between the two groups. Redness, swelling, heat and pain in eyelid was the most common clinical manifestations of orbital cellulitis in children, followed by fever, headache, runny nose, eye fixation, and vision loss. WBC count and neutrophils percentage were significantly higher in post-septal orbital cellulitis group. All children were followed up for 3 months to 3 years, 1 case was lost to follow-up, 50 cases had no recurrence and recovered well.Conclusion Orbital cellulitis is a common and rapid developing complication of sinusitis in children. Early diagnosis and effective anti-infection treatment are very important for prognosis. Orbital CT plays an important role in the determination and evaluation of this complication. When conservative treatment is ineffective, surgical drainage in time can reduce the occurrence of serious ocular sequelae.
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Key words:
- child /
- sinusitis /
- orbital cellulitis /
- complications
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表 1 眶隔前蜂窝织炎组和眶隔后蜂窝织炎组临床特点比较
组别 例数 病史时间/d 发热/ 例(%) 头痛/ 例(%) 流涕/ 例(%) 眼睑红肿热痛/ 例(%) 眼球固定/ 例(%) 视力下降/ 例(%) 眶隔前蜂窝织炎组 7 5.29±1.10 4(57.14) 2(28.57) 3(42.86) 7(100.00) 1(14.29) 1(14.29) 眶隔后蜂窝织炎组 44 5.19±1.90 24(54.55) 15(34.09) 11(25.00) 44(100.00) 13(29.55) 4(9.09) χ2检验/t检验 0.123 3 0.078 7 0.020 7 0.278 2 - 0.147 8 0.065 0 P值 0.902 3 0.779 0 0.885 6 0.597 9 1.000 0 0.700 7 0.798 8 
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表 2 眶隔前蜂窝织炎组和眶隔后蜂窝织炎组炎性指标比较
组别 白细胞计数/ (×109·L-1) 中性粒细胞百分比/% CRP/ (mg·L-1) 眶隔前蜂窝织炎组 16.11±1.41 74.88±7.8 47.86±30.81 眶隔后蜂窝织炎组 19.55±3.29 80.25±3.63 82.63±45.33 t值 -2.678 5 -2.910 9 -1.919 8 P值 0.010 0 0.005 4 0.060 7
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