儿童孤立性蝶窦炎的诊治体会

The diagnosis and management of isolated sphenoiditis in children

目的:回顾性分析儿童孤立性蝶窦炎的临床表现、诊断及治疗方式,以提高对该病的认识达到早期正确诊治。方法:对2001-06-2010-01期间收治的17例儿童孤立性蝶窦炎患者的临床资料进行回顾性分析。结果:17例患儿中主诉头痛9例,回吸黏脓涕中带血伴头痛、发热3例,鼻后滴漏伴头痛、低热5例。病史15d～1年不等。专科检查5例嗅裂少许黏脓涕引流,1例蝶筛隐窝处单发息肉,8例腺样体明显肥大,余无阳性体征,CT或MRI均示蝶窦炎或蝶窦积液。8例经抗生素规范治疗痊愈,余9例行鼻内镜下手术治疗,症状均缓解,随访1～5年无复发。结论:儿童孤立性蝶窦炎主要表现为不同程度及部位不定的头痛,少有鼻部症状,易误诊漏诊;CT或MRI是确诊的依据;治疗急性蝶窦炎可经抗生素规范治疗;慢性者应及时行鼻内镜手术治疗,蝶窦开放首选上鼻甲径路蝶窦自然开口开放术。

Objective：Analyzing the clinical manifestation,diagnosis and management of isolated sphenoiditis in children,retrospectively,was to get more information of the disease and to supply correct treatment early.Method：The symptoms,signs and imaging data of seventeen cases with isolated sphenoiditis hospitalized in our department from June 2001 to January 2010 were analyzed retrospectively.Result：Nine out of seventeen patients had the chief complaint of headache,three patients had blood in nasal discharge and had a fever,and five patients had postnasal drip with headache and a slight fever.The disease lasted for three months to one year.Five patients showed nasal discharge in rhinologic examination,one patient had solitary polyps in sphenoethmoid recess,eight patients had adenoid hypertrophy and the last three patients showed no positive signs.CT scan or MRI revealed opacification in sphenoid sinus.Eight patients received normative antibiotic therapy and were cured.The rest nine patients received endoscopic sinus surgery.The complaints relieved after the surgery and there was no signs of recurrence in 1 to 5 years of follow-up.Conclusion：Headache can be the chief and unique symptom of isolated sphenoiditis in children,which was easy to misdiagnose and miss diagnosis.CT or MRI was the evidence of diagnosis.Antibiotic therapy could be used for acute sphenoiditis.Patients with chronic sphenoiditis should receive endoscopic sinus surgery as early as better.From supraturbinal to sphenoid sinus natural ostia is the best way in sphenoidotomy.