眼眶及眶周脓肿17例临床分析

Clinical analysis of orbital and periorbital abscess in 17 patients

目的探讨眼眶及眶周脓肿的病因、临床特征及治疗原则。方法回顾性系列病例研究。收集天津市第一中心医院眼科2010年7月至2015年11月收治的17例眼眶及眶周脓肿患者的临床资料，所有患者均详细记录病史、病因、脓肿位置、副鼻窦受累情况、眼球受累情况、微生物学检测结果、影像学特征、治疗过程及预后等，进行总结分析。结果17例患者中男性10例，女性7例，年龄3.0-71.0岁，平均33.9岁；17例患者均行分泌物或脓液细菌培养，其中8例培养结果阳性；眼眶及眶周脓肿患者可出现视力下降、眼睑红肿、结膜充血水肿、眼球运动障碍、眼球受压移位甚至变形、眶压增高、脓肿破溃等临床表现；CT表现为软组织密度肿块影,位于骨膜下者，呈＂梭形＂或＂吊棚样＂，相邻副鼻窦可有炎性或占位表现；MR表现为长T1长T2信号影，脓肿内信号不均，并可见低信号骨膜影；眼眶及眶周脓肿的病因主要是副鼻窦炎症，其他还包括外伤、手术、副鼻窦肿瘤、糖尿病等；17例患者的治疗策略包括经鼻内窥镜下鼻窦开放术联合外路脓肿清除术，单纯外路脓肿清除术，单纯经鼻内窥镜下鼻窦开放术，外路脓肿切开引流治疗，单纯抗感染保守治疗；16例患者预后良好，未出现视功能受损、眼球运动障碍、颅内感染等严重并发症；1例患者因治疗延误出现视网膜中央动静脉阻塞，视功能严重受损。结论眼眶及眶周脓肿病因复杂多样，多继发于副鼻窦炎性反应，也可继发于外伤、手术、肿瘤等；眼眶及眶周脓肿临床表现多为炎性反应及占位性特征，诊断关键在于明确病因；切开引流是主要治疗手段，必要时多科室联合手术，以避免发生严重并发症。

ObjectiveTo discuss the etiology, clinical features and treatment principles of the orbital and periorbital abscess.MethodsA retrospective case series of 17 cases with orbital and periorbital abscess between July 2010 and November 2015 were conducted. All patients, clinical data including medical history, etiology, abscess location, paranasal sinus involvement, eye involvement, microbiological test results, imaging features, treatment and prognosis were summarized and analyzed.ResultsIn all 17 patients, there were 10 males and 7 females with age from 3.0 to 71.0 years （the average age was 33.9 years）.Eight patients, bacterial cultures of the pus and secretion were positive in all 17 patients. Orbital and periorbital abscess patients could manifest decreased vision, redness and swelling of eyelid, conjunctival congestion and edema, ocular motility disorders, displacement of eyeball, increased orbital pressure, abscess rupture etc. CT showed us the soft tissue mass, accompanied with sinusitis or paranasal sinus mass. MR performed with the long T1 and T2 signals. The signals of the abscess cavity were not uniform. For the etiology,11 cases were secondary to sinusitis, including 1 case of diabetes; 2 cases with orbital fractures.One case was secondary to orbital fracture repairment surgery. One case was secondary to the remnant of sequestrum and foreign bodys in the wound after repairment surgery. One case was injured by the hard object. One case was secondary to paranasal sinuses large B-cell lymphoma. One case had diabetic history and the blood sugar was controlled unstablly. For the treatment, 7 cases were treated by the drainage surgery which was performed via the sinus with endoscopic and abscess resection performed via the skin.Two cases were treatment by the abscess resection only.One case was treated by the drainage surgery performed via the sinus with endoscopic only. Six cases were treated by the drainage surgery performed via the skin. One case was only administered intravenous antibiotic. Sixteen cases acquired well prognosis without serious complications except 1 case which occurred central retinal artery and vein occlusion. ConclusionsThe orbital and periorbital abscess is mainly a complication of paranasal sinus infection, or secondary to trauma, surgery, tumor, etc; Orbital and periorbital abscess always manifest inflammatory neoplastic clinical features, the key of the diagnosis is to make sure the etiology; Incision and drainage of the abscess is the main treatment method when necessary. We can do the surgery with other departments to avoid the occurrence of serious complications.