鼻内镜下眶壁部分切除治疗急性鼻源性眶骨膜下脓肿

Endonasal endoscopic surgery for acut orbital of intraorbital abscess

目的：探讨鼻内镜下眶壁部分切除治疗急性鼻源性眶骨膜下脓肿的治疗方法。方法：在全身应用头孢他啶及万古霉素24h后，全身麻醉下行病侧上颌窦、筛窦开放术，同时取鼻窦内脓性分泌物做细菌培养及‘药物敏感试验；对影响鼻窦引流或术后鼻腔清理的鼻中隔偏曲、肥大中鼻甲同期或择期进行处理；术后24h取出鼻腔填塞物，吸引器每日2次清理术腔渗出物，直至有新鲜肉芽组织完全覆盖创面；对于有细菌培养结果及药物敏感性者，更换抗生素，对于无结果者，继续应用头孢他啶及万古霉素5d。结果：全部患者未出现眶部、鼻腔、颅内及全身并发症，术后24～48h体温恢复正常，眼痛、眼胀、头痛症状明显改善，睑、球结膜水肿消腿明显，眼球活动度明显增加；术后13～22d，全部患者眼部体征恢复正常，随访6个月无复发，6例遗有间断性眼部胀痛感。结论：鼻内镜下眶壁部分切除治疗急性鼻源性眶骨膜下脓肿是安全性高、疗效显著，具有明显优点的治疗方式。

Objective：To study curative effects of endoscopic sinus surgery performed on orbital periosteum abscess. Method： Application of ceftazidime and vancomycin 24 h later , operation on maxillary sinus and ethmoid otomy were performed under general anesthesia, Meanwhile bacterial culture and drug sensitive test were per formed to the purulent secretion from accessory nasal sinuses. Nasal septum and middle turbinate,which hampered the drainaging or clearing in nasal cavity, were undertaken operation in same or second stage. After operation 24 h,the wadding in nasal cavity was removed, and the effusion in nasal cavity was suctioned for 2 times daily until wound surface was covered by fresh granulation. Patients were used ceftazidime and vancomycin for 5 days, in which some patients was replaced antibiotics by drug sensitive test. Result： No complications occured. Ophthalma gia, expanding of eye and headache were obviously improved, dropsy of blephara and chemosis were decreased ob viously and the movement of eye was increased much. After operation 13422 days, the physical sign in ocular re gion recovered normal in all patients, no recurrence occured during a 6 months follow--up , and only 6 patients presented discontinual pain in ocular region. Conclusion： Endonasal endoscopic surgery for acut orbital of intraorbital abscess is safe and effective technique with obvious privillage.