成人急性鼻-鼻窦炎眶并发症四例临床分析

Clinical analysis of orbital complications of acute rhinosinusitis in adults

目的分析成人急性鼻一鼻窦炎眶并发症的临床特点及诊断与治疗。方法回顾性分析2011年4月至2012年1月青岛大学医学院附属医院耳鼻咽喉头颈外科收治的4例保守治疗无效后行内镜手术或联合眉弓切口手术治疗的急性鼻一鼻窦炎眶并发症成年患者的临床资料。结果4例急性鼻一鼻窦炎患者中并发眶内脓肿2例、眶骨膜下脓肿者2例。其中2例患有糖尿病。所有患者术后随访9～19个月，全身症状及眼部症状均消失。结论成人急性鼻一鼻窦炎眶并发症临床上较少见，患者往往合并糖尿病等基础疾病，机体免疫力较低。在控制基础疾病的基础上，手术清除病灶同时联合药物治疗效果确切。

Objective To investigate the clinical features, diagnosis and surgical intervention for orbital complications of acute rhinosinusitis in adults. Methods Four adults patients with orbital complications of acute rhinosinusitis were restrospectively reviewed. After conservative managements failed, these patients were treated by transnasal endoscopic sinus surgery or combined with eyebrow incision. Results There were 2 cases with orbital abscess, 2 cases with subperiosteal abscess. Among them, 2 patients suffered from diabetes. After operation, constitutional symptoms and ocular symptoms disappeared in all 4 patients. CT was rechecked during the postoperative follow-up. The imaging showed that the orbital and nasal lesions were obviously relieved or disappeared. Conclusions The orbital complications of acute rhinosinusitis in adults are clinically rare. The patients are usually with lowered immunity or with underlying conditions, such as diabetes. On the basis of controlling basic diseases, the treatment outcome of orbital complications of acute rhinosinusitis in adults is affirmative by surgery and conservative managements.