自发性眼眶出血的针吸治疗分析

Needle aspiration method to treat spontaneous orbital hemorrhage

【摘要】目的探讨自发性眼眶出血的病因、临床特征及针吸法治疗的临床疗效。方法对2006年至2015年在中南大学湘雅医院眼科经针吸治疗的17例单眼自发性眼眶出血的病例进行回顾性研究。所有患者初诊时均行B超和眼眶CT平扫增强三维成像检查，并行出凝血功能和眼球突出度检查。在通过影像学检查确认出血位置、范围后，根据出血对患眼影响的程度在不同时间段行针吸法治疗，观察记录治疗效果和不良反应，抽出的液体例行细胞学检查。在治疗结束后1月通过临床和CT表现评估其疗效。所有患者随访6个月到1年，评估其有无复发及预后。结果所有患者经局部针吸法治疗自发性眼眶出血后，均抽得暗红色或咖啡色陈旧性血性液体，穿吸量2～7ml，治疗期间未出现明显不良反应。随访6个月至1年，15例完全康复，1例穿刺后出现反复出血，最后通过手术治愈。1例因出血量大，就诊时间迟，就诊时视力丧失，经穿刺眼部症状消失，但视力没有恢复。结论自发性眼眶出血严重影响视力者，可迅速穿刺抽出淤血。对出血较少，但已在眶内形成血肿造成视力下降，眼球运动障碍者，可先予以保守治疗，病情稳定后行局部针吸治疗。针吸法治疗自发性眼眶出血创伤小，疗效好，恢复快，复发少。

Objective To investigate the etiological factors and the clinical characteristics of spontaneous orbital hemorrhage, and the clinical efficacy of the aspiration method. Methods A retro- spective clinical study was done in 17 spontaneous orbital hemorrhage patients receiving the treat- ment of needle aspiration. All of them were required to have type-B ultrasonic, orbital CT, PT, APTT and the degree of exophthalmos. The liquid was tested by routine cytological examination. Ob- servations and clinical effects were evaluated after 1 month through clinical manifestation and orbital CT. After 6 months-I year, relapses and prognosis were evaluated. Results All the spontaneous orbit~ ai hemorrhage patients were sucked out 2-7ml remote hemorrhagic liquid like red wine or coffee, without obvious adverse reactions during the treatment. Among the 17 patients, 15 cases were abso- lutely recovered, 1 case was repeated bleeding, and finally treated by surgery. One case lost vision because of massive hemorrhage and delayed treatment, although the protopsis disappeared after treat- ment, the vision didn＇t reverse. Conclusions For patient whose vision has decreased sharply, can get treatment of needle aspiration immediately. While, for those with less blood lose, a loss of vi- sion and eye movement disorder, can be treated conservatively, then get local needle aspiration treat- ment after stability. Needle aspiration method to treat idiopathic orbital hemorrhage can achieve excel- lent clinical curative effect, slight trauma, rapid recovery, and less recurrence.