儿童急性鼻-鼻窦炎眶并发症的多学科治疗。
Interdisciplinary care in orbital complications of acute rhinosinusitis in children.
机构信息
Department of Pediatrics, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia.
Department of Otorhinolaryngology and Head and Neck Surgery, Sestre Milosrdnice University Hospital, Zagreb, Croatia, University of Zagreb, School of Medicine, Zagreb, Croatia.
出版信息
Indian J Ophthalmol. 2023 Jan;71(1):242-248. doi: 10.4103/ijo.IJO_798_22.
PURPOSE
Orbital cellulitis is a serious condition with potentially severe complications. Treatment requires interdisciplinary care and early introduction of antimicrobial therapy. In our tertiary center, a team of pediatricians, pediatric ophthalmologists, and otorhinolaryngologists successfully participated in the management of pediatric periorbital/orbital cellulitis. This study aimed to demonstrate our interdisciplinary approach and to investigate clinical profile and management of pediatric periorbital/orbital cellulitis.
METHODS
A retrospective chart review was performed of all pediatric patients hospitalized for periorbital and orbital cellulitis in a tertiary hospital center from September 15, 2016, to March 15, 2020.
RESULTS
A total of 26 children-median age 2.7 years (range 0.5-12)-were treated during the study period. Disease presentation was unilateral, mainly during winter (n = 12) and autumn (n = 12), without ophthalmoplegia/proptosis. Seven patients had orbital cellulitis (Chandler classification of ≥III) and were older (6.5 years, P = 0.011) with sinusitis (P < 0.001), required surgery (P = 0.004), underwent longer antimicrobial treatment (13 days, P < 0.001), and had a longer length of hospital stay (13.43 days, P = 0.001). Orbital cellulitis occurred in a median of three days (range 1-12) of acute rhinosinusitis. Radiological survey was performed in 11 patients, whereas six patients were treated surgically. All intraoperatively collected cultures (sinus swabs) were positive, whereas Streptococcus pyogenes and Peptostreptococcus were isolated in five cases. All patients fully recovered. No recurrence was documented.
CONCLUSION
Sinusitis is associated with severe orbital cellulitis and surgical management. Orbital cellulitis occurred early in the course of acute rhinosinusitis, as a distinctive presentation of rhinosinusitis. Interdisciplinary care and early management are crucial in treatment of pediatric periorbital/orbital cellulitis.
目的
眶蜂窝织炎是一种严重的疾病，可能导致严重的并发症。治疗需要多学科的护理和早期引入抗菌治疗。在我们的三级中心，一组儿科医生、小儿眼科医生和耳鼻喉科医生成功参与了小儿眶周/眶蜂窝织炎的管理。本研究旨在展示我们的多学科方法，并研究小儿眶周/眶蜂窝织炎的临床特征和治疗方法。
方法
对 2016 年 9 月 15 日至 2020 年 3 月 15 日期间在一家三级医院中心因眶周和眶蜂窝织炎住院的所有儿科患者进行回顾性病历分析。
结果
共有 26 名儿童（中位年龄 2.7 岁[范围 0.5-12]）在研究期间接受了治疗。疾病表现为单侧，主要发生在冬季（n=12）和秋季（n=12），无眼肌麻痹/眼球突出。7 名患者患有眶蜂窝织炎（Chandler 分类≥III），年龄较大（6.5 岁，P=0.011），伴有鼻窦炎（P<0.001），需要手术（P=0.004），接受了更长时间的抗菌治疗（13 天，P<0.001），住院时间更长（13.43 天，P=0.001）。眶蜂窝织炎在急性鼻-鼻窦炎发作的第 3 天（范围 1-12）中位数发生。对 11 名患者进行了影像学检查，6 名患者接受了手术治疗。所有术中采集的培养物（鼻窦拭子）均为阳性，5 例培养出化脓性链球菌和消化链球菌。所有患者均完全康复。无复发记录。
结论
鼻窦炎与严重的眶蜂窝织炎和手术治疗相关。眶蜂窝织炎在急性鼻-鼻窦炎早期发生，是鼻-鼻窦炎的一种特殊表现。多学科护理和早期治疗对儿童眶周/眶蜂窝织炎的治疗至关重要。
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