儿童急性鼻窦炎眶并发症的临床表现及治疗

Clinical manifestation and treatment of orbital complications following acute rhinosinusitis in children

目的探讨儿童急性鼻窦炎眶并发症的临床表现与治疗方法。方法回顾分析成武县人民医院耳鼻喉科2010年4月至2014年12月收治的16例急性鼻窦炎并发眶内感染患儿的临床资料。确诊后,对所有患儿行药物治疗,对于因眶蜂窝织炎并发视神经炎而致视力下降者行急诊手术治疗;对于眶骨膜下脓肿患儿,若药物治疗未见明显好转,立即行手术治疗。结果 16例患儿中,7例眶骨膜下脓肿经鼻窦开放+骨膜下脓肿引流手术治疗后痊愈;2例眶蜂窝织炎并发视神经炎而致视力下降的患儿,1例视力完全恢复,另1例仅有光感;7例眶蜂窝织炎、眶隔前蜂窝织炎经药物治疗后痊愈。结论儿童急性鼻窦炎眶并发症临床表现复杂,病情进展快,应尽早确诊,尽早治疗。眶蜂窝织炎、眶隔前蜂窝织炎经药物治疗可以痊愈,眶骨膜下脓肿、眶蜂窝织炎并发视神经炎应尽快手术治疗。

Objective To investigate the clinical manifestation and treatment methods of orbital complications following acute rhinosinusitis in children. Methods The clinical data of 16 children with orbital complications secondary to acute rhinosinusitis were retrospectively analyzed. After diagnosis,all the children were treated with drugs. For the children with impaired vision due to orbital cellulitis complicated by optic neuritis,emergency operation was performed. If the symptoms of children with subperiosteal abscess of the orbit were not improved after administration of drugs,the surgery was conducted immediately. Results Among 16 children,7 with subperiosteal abscess of the orbit were cured by sinus opening plus drainage for subperiosteal abscesses. Of the 2 with impaired vision due to orbital cellulitis complicated by optic neuritis,one had the vision recovered,while the other only had light sensation. Seven children with orbital cellulitis and preseptal cellulitis were also cured after administration of drugs. Conclusion Orbital complications following acute rhinosinusitis in children are characterized by complicated clinical manifestations and rapid progression,so they should be diagnosed and treated as soon as possible. The ophthalmologists and paediatricians should attach more importance to orbital complications owing to the presence of their initial symptoms around eyes. Both orbital cellulitis and preseptal cellulitis can be cured after administration of drugs,and surgery should be performed as soon as possible if subperiosteal abscesses and orbital cellulitis complicated by optic neuritis occur.