摘要
目的:提高鼻内镜手术的安全性和减少术后眼部并发症。方法:报告和分析3例慢性鼻窦炎和鼻息肉患者经鼻内镜手术及凡士林纱条填塞后并发的眼睑脂肪肉芽肿及其处理。结果:3例均因经鼻内镜手术时损伤同侧眶内壁纸板,术后2~3h出现眶周肿胀、眼睑淤血和睑结膜水肿,10~24h内抽出鼻腔凡士林纱条,6~8d眼部肿胀和眼睑淤血消退、鼻腔通气良好出院。术后12~15d出现同侧眼睑肿胀和眼脸皮下结节性肿块(左上睑1例,右下睑2例),眼球活动和视力正常。静脉用抗生素和糖皮质激素治疗3~4周仅能暂时减轻眼睑肿胀。术后1~6个月经睑缘切口,完全切除眼睑内肿块后痊愈,术后病理诊断为脂肪肉芽肿。随访4~18个月无任何眼部不适和复发。结论:鼻内镜手术损伤眶纸板和出血,以及凡士林纱条填塞致凡士林渗入眼睑内是产生眼睑脂肪肉芽肿的直接原因;确认有眶纸板损伤后不宜用凡士林纱条作为止血填塞;彻底清除眼睑内肉芽肿病灶是最有效的方法。
Objective:To enhance the safety of nasal endoscopic surgery and decrease its complications of eyes. Method:Three patients of chronic rhinosinusitis and nasal polyposis with lipogranulomas of the eyelids after nasal endoscopic surgery and nasal packing of petrolatum gauze were reported and analyzed, and their treatment results were presented during the last 2 years. Result: The medial orbital wall injury occurred in all three patients during endoscopic sinus surgery. The patients developed an ipsilateral perioular swelling, eyelid hematoma and calpebral conjunctival edema during 2 to 3 hours after surgery. Nasal packs petrolatum gauze were removed 10~24 hours after ssurgery. The patients were discharged from hospital when periorbital swelling and eyelid ecchymoma disappeared, and nasal cavity obstruction was improved 6 to 8 days after surgery. The swelling and nodular mass of ipsilateral eyelids (one in left upper eyelid and two in right lower eyelid) were found 12~15 days after surgery, and their eye movement and eyesight were normal. Antibiotic and corticosteroid were administered for 3~4 weeks with only improvement in eyelid swelling. These masses of eyelids were completely excised through palpebral margin 1~6 months after surgery. The histopathological examination of the surgical specimens showed lipogranuloma. No recurrence and symptom of the eyes had been observed during 4~18 months follow up. Conclusion: The lipogranuloma of the eyelid is a rare and late complication after nasal endoscopic surgery and nasal packing with vaspetrolatum gauze. The medial orbital wall injury and bleeding during surgery, and vaseline of nasal packing permeated into the eyelid are the direct causes of this complication. The application of petrolatum gauze should be avoided when the medial orbital wall trauma is identified. The complete excision of granulomas is a best effective therapy.
出处
《临床耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2007年第8期340-343,共4页
Journal of Clinical Otorhinolaryngology Head And Neck Surgery
关键词
内镜术
手术后并发症
脂肪肉芽肿
眼睑
Endoscopic
Postoperative complication
Lipogranulomas
Eyelids