鼻内镜手术眶纸样板损伤的原因及处理

Causes and treatment of orbital paperacea damage in endoscopic sinus surgery

目的:探讨鼻内窥镜手术过程中并发眶纸板损伤原因及处理的方法。方法:选择眶纸板损伤2例临床资料,均在鼻内窥镜下进行手术。结果:鼻内窥镜手术一旦发生眶纸样板损伤,出现眶周淤血,眶压增高,视力模糊等情况,要高度重视,及时处理,抽出鼻腔油纱条以利引流。结论:鼻窦手术前,通过仔细阅读鼻窦CT及鼻内镜检查等手段识别鼻腔、鼻道窦口复合体的解剖。出现眶纸板损伤时,术腔尽可能不填塞或少填,眶纸板破损处不用油纱填塞,留一个通向总鼻道的间隙,是可行且较常规填塞具有一定优越性。使用止血药及物理降温防止继续出血,静脉滴注地塞米松可减轻组织水肿,减轻视神经受压降低内压避免引发严重后果。

Objective：To investigate the causes and treatment of orbital paperacea damage in course of endoscopic sinus surgery.Methods： Two cases with orbital paperacea damage who accepted operation under the endoscope were analyzed.Results： Endoscopic sinus surgery in case of injury of the orbital model paper appears orbital congestion,increased orbital pressure,blurred vision,etc.,should attach great importance,in time,out of gauze to facilitate the drainage of the nasal cavity.Conclusion： The sinus surgery before,carefully read through the sinus CT and nasal endoscopy and other means of identification of the nasal cavity,nasal sinus complex anatomy.Papyracea injury occurs,surgery is not possible,cavity filling,or less filling,not on broken orbital cardboard packing gauze,leaving a gap leading to the total nasal airway is feasible and has certain advantages compared with conventional packing.Use of hemostatic and physical cooling to prevent further bleeding,intravenous drip to Cyprus for the pine to reduce edema,relieve internal pressure to prevent optic nerve compression reduces serious consequences.