儿童急性鼻窦炎并发眶壁骨膜下脓肿

Subperiosteal orbital abscess secondary to acute sinusitis in children

目的探讨儿童急性鼻窦炎并发眶壁骨膜下脓肿的临床特征及治疗方法的选择。方法回顾分析武汉大学人民医院耳鼻咽喉-头颈外科1996年6月至2005年10月收治的35例5～12岁儿童急性鼻窦炎并发眶壁骨膜下脓肿的临床表现、CT扫描特征和不同治疗效果。结果13例（37．1％）仅通过药物控制感染，22例（62．8％）行鼻内窥镜下眶壁骨膜下脓肿引流。比较药物治疗组和鼻内窥镜下脓肿引流组的疗效：前者无视力下降，后者有9例视力下降；前者2例结膜水肿，后者14例；前者5例眼球移位，后者17例；前者无眼内压增加者，后者13例；前者无眼球活动受限，后者14例；CT显示前者脓肿宽明显小于后者（O．21cm vs 1．35cm）。结论对视力下降、眼球移位、眼球活动受限、眼内压〉20mmHg、脓肿宽〉4mm的儿童。应行鼻内窥镜下眶壁骨膜下脓肿切开引流术。

Objectiv To explore the clinical features and treatment methods for subperiosteal orbital abscess secondary to acute sinusitis in children. Method The clinical features, computed tomographs and outcomes of different treatments for 35 children from 5 to 12 years old with subperiosteal orbital abscess secondary acute sinusitis were respectively analyzed. Results 13 cases were treated only by drugs and 22 by endoscopic drainages. The effects between the two groups were as follows： none in the former and 9 in the latter had a sight descent, 2 in the former and 14 in the latter had chemosis, 5 in the former and 17 in the latter had an eyeball displacement, none in the former and 13 in the latter had elevated intraocular pressure, and none in the former and 14 in the latter had extra-ocular movement restriction. The width of abscess in the former was significantly less than that in the latter （0.21cm vs 1.35cm）. Conclusions Endoscopic drainage should be applied for pediatric subperiosteal orbital abscess patients with sight descent, eyeball displacement, restriction of extraocular movements, intraocular pressure 〉 20 mmHg and abscess width 〉 4mm.