24例眼眶异物诊断和治疗分析

Problems in diagnosis and treatment of orbital foreign body-an analysis of 24 cases

目的分析目前眼眶异物诊断和治疗中存在的问题。方法回顾性系列病例研究。收集2002年5月至2007年5月收治的眼眶异物患者24例，根据其临床和影像学资料了解目前眼眶异物诊断和治疗中存在的问题。结果植物性异物11例，金属异物6例，玻璃异物2例，其他5例。18例曾行清刨缝合术，12例曾行异物取出术，7例曾行3次以上各类手术。诊断和治疗中存在的问题：（1）受伤情况询问不详、对眶内异物存留认识不足；（2）未进行必要的CT检查；（3）不能正确阅读CT片，CT显示异物而未能诊断；（4）急诊清创处理、以及后续的化脓性感染切开引流，均未进行必要的探查；（5）对植物性和塑料异物，仅满足术中取出一个或数个异物；（6）对眼眶解剖结构不熟悉，手术技术不熟练，不能取出异物甚至将其推向深处；（7）再次手术时未重新进行必要的CT检查；（8）麻醉方式选择不当。局部麻醉下，患者不能耐受手术。结论眼科医师应掌握眶内解剖结构、影像学和眶内异物的诊断，熟悉眼眶手术入路，提高异物取出成功率，减少手术并发症。

Objective To evaluate the problems presented in the diagnosis and treatment of orbital foreign body. Methods This was a retrospective case series. We reviewed and analyzed 24 cases of orbital foreign bodies treated by us in the past 5 years. Results Twenty four orbital foreign body cases were treated by the authors from May 2002 to May 2007. Eleven cases were plant foreign bodies, 6 cases were metallic foreign bodies, 2 cases were glass foreign bodies and 5 cases were other types of foreign bodies. Wound cleaning operations were performed in 18 cases. Foreign body removal surgery was performed in 12 cases. In 7 cases, three or more operations were undertaken. The problems presented in the diagnosis and treatment of orbital foreign body included： （1）History taken was inadequate and failed to recognize the presence of orbital foreign body. （2）The necessary CT examination was not perfromed. （3）CT films was not read correctly and failed to detect the orbital foreign bodies. （4）An exploration operation was not performed during the emergency operation and subsequent operation for draining of pyogenic infection. （5）Only part of the wood or plastic fragments were removed during the operation. （ 6 ） Foreign bodies could not be extracted or were pushed deeply clue to unfamiliar with the structure of the orbit, lack of adequate surgical skills or absence of necessary instruments. （7）A second CT examination was not performed and foreign body was not re-localized before the second surgery. （8）An inappropriate anesthesia method were selected （such as using local anesthesia insteand of general anesthesia ） so that the patient could not stand the painful operation. Conclusions Many problems presented in the diagnosis and treatment of orbital foreign body, including the handling of the structure of the orbit, correct reading of CT imaging and diagnosis of orbital foreign body, well-informed operative approach, increasing the removal of orbital foreign body and decreasing the complications, these should be focused by ophthalmic surgeons.