鼻源性眶骨膜下脓肿的诊治策略

Diagnosis and treatment of rhinogenic subperiosteal abscess

目的探讨鼻窦炎引起的眶骨膜下脓肿的临床特征及治疗策略。方法回顾分析16例鼻源性眶骨膜下脓肿的临床资料,包括成人11例、儿童5例。11例成年患者入院24 h内行眶骨膜下脓肿引流及内镜下鼻窦开放,其中5例眶骨膜下脓肿位于眶内侧或内下方者采取经鼻窦引流,6例位于眶上方者采取B超引导下穿刺引流。5例儿童患者采取抗感染治疗,其中1例症状无好转而改行手术。结果 15例治愈,随访6-32个月无复发;1例因合并颅内感染死亡。结论鼻源性眶骨膜下脓肿应根据脓肿部位与患者年龄采用不同的治疗方法,以达到微创目的;尽早行鼻窦引流消除原发感染病灶,高度警惕合并颅内并发症。

Objective To study the clinical features and therapeutic strategies of subperiosteal abscess caused by sinusitis.Methods Data of 16 cases with rhinogenic subperiosteal abscess were analyzed retrospectively .In the 16 cases, there were 11 adults and 5 children.The 11 adult patients received subperiosteal abscess drainage and endoscopic sinus surgery at the same time .Five cases were treated by using sinus drainage as the subperiosteal abscess located within or below the medial orbital;6 cases with abscess located above the orbital were given type-B ultrasonography guided puncture drainage . Five pediatric patients accepted anti-infection treatment , in which one case without obvious improvement diverted for operation .Results During the follow-up of 6-32 months, fifteen cases were cured and one patient died of intracranial infection .Conclusions Rhinogenic subperiosteal abscess should be given different treatment based on the location of the abscess and the age of patient in order to achieve minimal invasion .Sinus drainage should be given as soon as possible to eliminate the primary infection lesions and to avoid intracranial complications.