Cao Yuan, Song Qing, Zhang Tian, Liu Zhonglu, Sun Yan, Mao Ning, Wang Hongbo, Chen Xiumei, Song Xicheng
Department of Otorhinolaryngology Head and Neck Surgery,Yantai Yuhuangding Hospital,Qingdao University,Yantai,264000,China.
Weifang Medical University,Clinical Medical College.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Feb;35(2):125-130. doi: 10.13201/j.issn.2096-7993.2021.02.008.
The aim of this study is to explore the diagnosis, clinical manifestations and surgical treatment experience of acute sinusitis complicated with orbital subperiosteal abscess. The clinical data of 11 patients with acute sinusitis complicated by orbital subperiosteal abscess from 1 year and 8 months to 50 years were retrospectively analyzed, including clinical manifestations, imaging manifestations, bacteriological examinations, surgical methods and therapeutic effects. All patients were given antibacterial drugs, glucocorticoids, and surgery. All 11 patients had unilateral lesions. The imaging examinations all supported the appearance of orbital subperiosteal abscess. Nine patients underwent nasal endoscopic sinus opening+SPOA incision and drainage, 2 patients underwent nasal endoscopic sinus opening+ultrasound guided abscess puncture. Eyelid swelling and exophthalmia of all patients were alleviated when discharged. Ten of the 11 patients had no visual acuity change, and one patient had light perception only when she came to the hospital and recovered to 0.05 when discharged, there was no change in visual acuity after 3 months follow-up. The bacterial cultures of nasal secretion or pus were positive in 7 cases, the main pathogenic bacteria were Staphylococcus aureus(3 cases, includes one case of MRSA), Streptococcus anginosus(2 cases), and Streptococcus intermedius(2 cases). Rhinogenous orbital subperiosteal abscess has a rapid onset and progresses quickly. Once an abscess is formed, patients with poor conservative treatment should choose surgical treatment as soon as possible. The most common surgical method is nasal endoscopic sinus opening+SPOA incision and drainage. If the abscess is located above or above the eyeball, puncture or incision and drainage should be combined with ultrasound guidance.
本研究旨在探讨急性鼻窦炎合并眶骨膜下脓肿的诊断、临床表现及手术治疗经验。回顾性分析11例病程1年8个月至50岁的急性鼻窦炎合并眶骨膜下脓肿患者的临床资料,包括临床表现、影像学表现、细菌学检查、手术方法及治疗效果。所有患者均给予抗菌药物、糖皮质激素及手术治疗。11例患者均为单侧病变。影像学检查均支持眶骨膜下脓肿表现。9例行鼻内镜鼻窦开放+眶骨膜下脓肿切开引流术,2例行鼻内镜鼻窦开放+超声引导下脓肿穿刺术。所有患者出院时眼睑肿胀及眼球突出均缓解。11例患者中10例视力无变化,1例患者入院时仅有光感,出院时恢复至0.05,随访3个月后视力无变化。鼻分泌物或脓液细菌培养7例阳性,主要病原菌为金黄色葡萄球菌(3例,其中1例为耐甲氧西林金黄色葡萄球菌)、咽峡炎链球菌(2例)、中间型链球菌(2例)。鼻源性眶骨膜下脓肿起病急、进展快。一旦形成脓肿,保守治疗效果不佳的患者应尽早选择手术治疗。最常用的手术方法是鼻内镜鼻窦开放+眶骨膜下脓肿切开引流术。若脓肿位于眼球上方或眼球以上,应在超声引导下穿刺或切开引流。