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[内镜下经鼻泪囊鼻腔造口术中的球后血肿]

[Retrobulbar hematoma in endoscopic endonasal dacryocystorhinostomy].

作者信息

Yartsev V D, Atkova E L, Danilov S S

机构信息

Research Institute of Eye Diseases, Moscow, Russia.

出版信息

Vestn Otorinolaringol. 2021;86(1):112-116. doi: 10.17116/otorino202186011112.

Abstract

Recently, an increase in the number of operations on the lacrimal ducts performed by otorhinolaryngologists has been noted throughout the world. During these operations, intra- and postoperative complications may develop, which require the intervention of an ophthalmologist. A rare complication of endoscopic dacryocystorhinostomy is the development of retrobulbar hemorrhage. This article presents a clinical case of the development of retrobulbar hemorrhage in endoscopic dacryocystorhinostomy. The patient with dacryocystitis underwent endoscopic dacryocystorhinostomy. Preoperative computed tomography revealed a lack of bone tissue in the lacrimal sac fossa. Severe bleeding was noted during the operation. Against the background of tamponade of the formed anastomosis, a growing exophthalmos, conjunctival chemosis, subconjunctival hemorrhage were noted. After removing the tampon, a positive trend was noted. Dexamethasone solution was intraoperatively intravenously administered, in the postoperative period - methylprednisolone solution. According to computed tomography data, exophthalmos persisted on the first day after the operation, hematoma was localized. Visual functions are unchanged. Six months after the operation, the patient had no complaints. According to the computed tomography data, a functioning dacryorhinostomy anastomosis was determined. Often, an interdisciplinary approach to such complications is required, since it can provide full orbital decompression, as well as adequate postoperative management of the patient, which contributes to the most complete ophthalmic rehabilitation. The interaction of otorhinolaryngologists and ophthalmologists in such cases is an indispensable condition for the safety of the operation.

摘要

最近,全世界都注意到耳鼻喉科医生进行泪道手术的数量有所增加。在这些手术过程中,可能会出现术中及术后并发症,这就需要眼科医生进行干预。内镜下泪囊鼻腔造口术的一种罕见并发症是球后出血。本文介绍了一例内镜下泪囊鼻腔造口术并发球后出血的临床病例。一名患有泪囊炎的患者接受了内镜下泪囊鼻腔造口术。术前计算机断层扫描显示泪囊窝缺乏骨组织。手术过程中出现严重出血。在对形成的吻合口进行填塞的背景下,出现了眼球突出加重、结膜水肿、结膜下出血。取出填塞物后,情况出现好转趋势。术中静脉注射地塞米松溶液,术后使用甲基泼尼松龙溶液。根据计算机断层扫描数据,术后第一天眼球突出仍然存在,血肿已定位。视觉功能未改变。术后六个月,患者无不适主诉。根据计算机断层扫描数据,确定泪囊鼻腔造口吻合口功能良好。通常,对于此类并发症需要采取多学科方法,因为它可以提供充分的眼眶减压以及对患者进行充分的术后管理,这有助于实现最全面的眼科康复。在这种情况下,耳鼻喉科医生和眼科医生的合作是手术安全不可或缺的条件。

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