期刊文献+

鼻内镜术致失明的预防和处理(附3例报告) 被引量:7

Prevention and management of blindness following endonasal sinus surgery
原文传递
导出
摘要 目的:探讨鼻内镜术致失明的预防和处理。方法:报告3例慢性鼻窦炎和鼻息肉患者于鼻内镜手术中损伤眼部结构和碘仿凡士林纱条填塞后并发的失明及其处理方法。结果:3例中2例因鼻内镜手术时损伤同侧眶内壁纸板和眶内组织结构,术中1例眼球变形、失明,立即行眶内视神经探查和眼内肌修复;1例出现眶周肿胀、眼睑淤血和睑结膜水肿,术后2d失明,清除眶内血肿及行视神经减压术。另1例术中筛窦填塞立即失明,抽出填塞物视力恢复。术后3例患者静脉用大剂量抗生素、糖皮质激素和神经生长因子治疗4周。随访6个月1例视力正常;1例失明,眼球萎缩;1例光感。结论:鼻内镜手术损伤眶内容物和出血,是失明的原因;术前CT检查示后筛窦呈过度气化者,术中应注意视神经骨管是否缺损;确认眶纸板损伤者一般不宜行鼻腔填塞;术后视力下降明显者应立即行视神经减压。 Objective:To explore the causes and the management of serious eye complications occurring in the endoscopic sinus surgery. Method:Three patients of chronic sinusitis and nasal polyps suffered with blindness in endoscopic sinus surgery and in nasal packing with iodoform and petrolatum gauze were treated. Result: Orbital wall and structure were injured in 2 cases during endoscopic sinus surgery, among which, 1 case blinded with deformation of the eyeball during operation underwent optic nerve exploration and orbital muscle reparation immediately. One case developed perioular swelling, eyelid hematoma, conjunctiva edema and blinded 2 days later, and was treated with hematoma clearance and optic nerve decompression. Another 1 case blinded immediately after ethmoid packing, and vision recovered after nasal pack removed. Antibiotics, corticosteroid and nerve growth factor were administered for 4 weeks in all patients. After 6-month follow-up, 1 case was blinded with eyeball atrophy, 1 case was only photonasty, another regained normal vision. Conclusion:The causes of blindness in endoscopic sinus surgery are directly related to orbital structure trauma and orbital hematoma. The optic nerve during operation should be protected carefully, if ethmoid sinus over development is demonstrated by CT scan. The application of gauze should be avoided when the medial orbital wall is injured. Decompression of optic nerve should be performed as early as possible, if vision damaged.
出处 《临床耳鼻咽喉头颈外科杂志》 CAS CSCD 北大核心 2009年第8期349-351,共3页 Journal of Clinical Otorhinolaryngology Head And Neck Surgery
关键词 鼻内镜术 并发症 失明 endoscope surgery complication blindness
  • 引文网络
  • 相关文献

参考文献8

  • 1MCMAINS K C. Safety in endoscopic sinus surgery [J]. Curr Opin Otolaryngol Head Neck Surg,2008, 16: 247-251.
  • 2王杰,董钏,付启红,胥斌,杨德满.鼻内镜手术并发症与解剖因素关系探讨[J].华西医学,2005,20(1):81-82. 被引量:3
  • 3BHATTI M T. Neuro ophthalmic complications of endoscopic sinus surgery[J]. Curr Opin Ophthalmol, 2007,18:450-458.
  • 4DALZIEL K, STEIN K, ROUND A, et al. Endoscopic sinus surgery for the excision of nasal polyps: A systematic review of safety and effectiveness[J]. Am J Rhinol,2006,20:506-519.
  • 5裴嘉红,安惠民,乔晓明,梁传余.鼻内镜手术致右眼失明1例[J].西部医学,2005,17(3):288-288. 被引量:2
  • 6THACKER N M, VELEZ F G, DEMER J L, et al. Extraocular muscle damage associated with endoscopic sinus surgery: an ophthalmology perspective[J]. Am J Rhinol, 2005,19 : 400 - 405.
  • 7罗恒茂,裴春明.鼻内镜手术中控制性降压麻醉后动脉压、心率与术野出血的关系[J].耳鼻咽喉(头颈外科),2003,10(6):347-348. 被引量:31
  • 8ULUALP S O. Complications of endoscopic sinus surgery: appropriate management of complications [J]. Curr Opin Otolaryngol Head Neck Surg,2008, 16:252 -259.

二级参考文献11

共引文献33

同被引文献29

  • 1刘学兵,李波,刘钢,赵绰然.内镜鼻窦手术并发视网膜中央动脉阻塞一例[J].中华耳鼻咽喉科杂志,2004,39(7):441-441. 被引量:10
  • 2李智深,宫丽丽,张士红,李少平.鼻窦内窥镜手术严重并发症的预防及处理(附3例报告)[J].山东大学耳鼻喉眼学报,2005,19(5):308-310. 被引量:2
  • 3文忠.后组鼻窦炎的临床特征分析及鼻内镜手术[J].中国眼耳鼻喉科杂志,2006,6(6):344-346. 被引量:1
  • 4STANKIEWICZ J A,CHOW J M.Two faces of orbital hematoma in intranasal (endoscopic) sinus surgery[J].Otolaryngol Head Neck Surg,1999,120(6):841-847.
  • 5王景昭.视网膜病//葛坚.眼科学[M].北京:人民卫生出版社,2002:179-195.
  • 6HATTON M P,RUBIN P A.Management of orbital compartment syndrome[J].Arch Ophthalmol,2007,125(3):433-434.
  • 7STANKIEWICZ J A. Comments about postoperative care after endoscopic sinus surgery[J]. Arch Otolaryngol Head NeckSurg,2002,128:1207-1208.
  • 8CasianoRR.鼻内镜鼻窦手术操作图谱[M].北京:人民卫生出版社,2004:20-39.
  • 9James G. Krings,Dorina Kallogjeri,Andre Wineland,Kenneth G. Nepple,Jay F. Piccirillo,Anne E. Getz.Complications of primary and revision functional endoscopic sinus surgery for chronic rhinosinusitis[J]. The Laryngoscope . 2014 (4)
  • 10Fatma H. Al Anazy,Surayie H. Al Dousary.Ophthalmic manifestations of paranasal sinus disease: a clinical grading system[J]. International Forum of Allergy & Rhinology . 2012 (4)

引证文献7

二级引证文献14

;
使用帮助 返回顶部