儿童鼻窦炎眶并发症诊治31例及文献分析

Clinical diagnosis and treatment of orbital complications following pediatric acute rhinosinusitis

目的探讨儿童鼻窦炎眶并发症发病特点、诊断方法及治疗原则。方法对31例鼻窦炎引发眶并发症儿童患者临床资料进行回顾性分析和总结。结果儿童鼻窦炎眶并发症具有不同发展阶段及相应临床特点、影像学表现,本组所有病例全部临床治愈出院,随访时间6~24个月,无复发者,遗留睑外翻和鞍鼻各1例,未出现海绵窦化脓性炎症和颅内感染等严重并发症。脓液及鼻分泌物细菌培养阳性率达55%,其中金黄色葡萄糖球菌4例,肺炎链球菌4例。结论儿童鼻窦炎眶并发症冬春季节高发,男童居多,与上呼吸道感染关系密切。首发症状不典型,常首诊于其他科室而延误诊治。治疗原则是早期应用足量、敏感抗生素控制感染,头孢哌酮钠舒巴坦钠是治疗儿童鼻源性眶并发症首选经验用药。保守治疗无效者,结合其临床及影像学表现变化,判断疾病所处阶段,严格把握手术指征,可获得满意疗效。

Objective To study the clinical features and therapeutic strategies for orbital complications of pediatric rhinosinusitis.Methods The clinical data of 31 children with orbital complications caused by sinusitis treated in the Department of Otorhinolaryngology Head and Neck Surgery from October 2010 onwards were retrospectively analyzed and summarized.Results The orbital complications of pediatric sinusitis have different stages,which correspond with clinical characteristics and imaging findings.All cases were cured and discharged from our hospital.No recurrence occurred during the follow-up period of 9 to 24 months.One case was left with an eyelid ectropion,and one with a saddle nose.No serious complications such as cavernous sinus suppurative inflammation or an intracranial infection occurred.The bacterial culture rate in the patients pus and nasal secretions was 55%,including 4 cases of Staphylococcus aureus and 4 of Streptococcus pneumoniae.Conclusions In children,orbital complications caused by sinusitis occur more often in winter and spring,and males.It is closely related to other upper respiratory tract infections.The primary symptoms are atypical resulting in delayed treatment.Adequate and sensitive antibiotics should be used to control any infection early.Cefoperazone sodium and sulbactam sodium are usually used for treating children with rhinogenic orbital complications.If conservative treatment is ineffective,the stage of the disease should be assessed along with any changes in clinical and imaging manifestations examined.Satisfactory results can be obtained according to surgical indications.