幼儿急性鼻窦炎眶内并发症治疗的回顾性分析

Retrospective analysis of management of orbital complications of acute sinusitis in infant patients

目的探讨幼儿急性鼻窦炎眶内并发症不同治疗方式的效果。方法回顾性分析2008年11月～2011年1月就诊于北京同仁医院的117例鼻窦炎患儿中,年龄≤3岁的幼儿急性鼻窦炎眶内并发症的8例患儿的诊治过程及随访结果。结果 8例患儿中,男性7例(87.5%),女性1例(12.5%)。平均年龄1岁9个月(1～3岁)。急性鼻窦炎合并眶蜂窝织炎2例(25%),合并眶骨膜下脓肿6例(75%)。合并眶骨膜下脓肿的6例患儿中2例行功能性鼻内镜手术治疗,其余6例患儿采用局部及全身药物治疗。手术治疗患儿随访6个月、2年5个月,药物治疗患儿随访3个月～2年3个月,所有患儿治愈后均未出现症状复发。结论急性鼻窦炎眶内并发症的治疗,对于年龄较小的患儿可采用全身抗感染治疗替代手术治疗,减少手术并发症及对患儿颅面部发育的影响,是一种临床观察有效的治疗手段。

OBJECTIVE To compare the effect of different treatments to orbital complications of acute rhinosinusits in infant patients.METHODS The clinical data of 8 infant patients with orbital complications of acute rhinosinusitis was retrospectively analyzed.These patients were younger than 3 years old and hospitalized in one center between November 2008 and January 2011.RESULTS In the 8 cases,there were 7 boys（87.5%） and one girl（12.5%）,with a mean age of 1 year 9 months old.The main presentation were eyelid swelling,bulging eyeball,and having fever with nasal obstruction,purulent rhinorrhea and overflow without vision decreasing or disorder of eyeball movement.All of the orbital lesions were unilateral,with 5cases in left side（62.5%） and 3 cases in right side（37.5%）.Complications of acute rhinosinusitis were 2 cases of periorbital cellulitis（25%） and 6 cases of subperiosteal abscess（75%）.The two infants with subperiosteal abscess were received functional endoscopic sinus surgery（FESS）.The other 4 patients with subperiosteal abscess and 2 patients with periorbital cellulitis were received topical and systemic maximal medical therapy.During follow-up from 3 to 29 months,eight patients were cured without any symptom recurred.CONCLUSION The most patients with orbital complications of acute rhinosinusitis can be cured by systemic maximal medical treatment,and FESS is not suggested in these infant patients because of the complex technique and postoperative complications.