Dai Bao, Wang Xueping, Liu Lei, Jin Xianlang, Zhang Rui, Deng Wenjing, Wang Ying, Zhao Yulin
Department of Rhinology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,450052,China.
Department of Neurology,the First Affiliated Hospital of Zhengzhou University.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2024 Aug;38(8):747-749;754. doi: 10.13201/j.issn.2096-7993.2024.08.014.
To compare the efficacy of endoscopic sinus surgery and conservative treatment for orbital apex syndrome caused by sinus lesions. The clinical data of 56 patients with orbital apex syndrome caused by sinus lesions who were admitted to the First Affiliated Hospital of Zhengzhou University from January 2018 to August 2023 were retrospectively analyzed and divided into a surgical group of 21 cases and a conservative group of 35 cases. The clinical features and prognosis of the two groups were compared. Among the sinus lesions in the surgical group, 61.9% were fungal sinusitis, 28.6% were bacterial sinusitis, and 9.5% were sphenoid sinus tumors. In the conservative group, non-fungal sinusitis accounted for 65.7% and fungal sinusitis accounted for 34.3%. In addition to sinus lesions, patients had underlying diseases. In the surgical group, 71.4% had hypertension and 80.9% had diabetes; in the conservative group, 28.6% had hypertension and 42.9% had diabetes. After a follow-up of 1 month to 5 years, the symptom improvement rate in the surgical group was 85.7%, with 1 case of recurrence. No recurrence was found after reoperation, while the symptom improvement rate in the conservative group was 22.9%, and 6 cases recurred after symptom improvement, and were transferred to rhinology department. No recurrence was seen after surgery. Most of the sinus lesions in this study were fungal sinusitis. In addition, patients with underlying diseases such as diabetes, hypertension, nephrotic syndrome, etc. have reduced nasal immunity, which significantly increases the risk of disease. Since early nasal symptoms are not obvious, multidisciplinary cooperation in diagnosis and treatment is very necessary. Once imaging examination suggests orbital apex syndrome caused by sinus lesions, endoscopic sinus opening should be performed as soon as possible.
比较内镜鼻窦手术与保守治疗鼻窦病变所致眶尖综合征的疗效。回顾性分析2018年1月至2023年8月郑州大学第一附属医院收治的56例鼻窦病变所致眶尖综合征患者的临床资料,分为手术组21例和保守组35例。比较两组的临床特征及预后。手术组鼻窦病变中,真菌性鼻窦炎占61.9%,细菌性鼻窦炎占28.6%,蝶窦肿瘤占9.5%。保守组中,非真菌性鼻窦炎占65.7%,真菌性鼻窦炎占34.3%。患者除鼻窦病变外,均有基础疾病。手术组中,71.4%有高血压,80.9%有糖尿病;保守组中,28.6%有高血压,42.9%有糖尿病。随访1个月至5年,手术组症状改善率为85.7%,复发1例,再次手术后未复发;保守组症状改善率为22.9%,症状改善后复发6例,转至鼻科,手术后未见复发。本研究鼻窦病变以真菌性鼻窦炎居多。此外,糖尿病、高血压、肾病综合征等基础疾病患者鼻免疫力降低,疾病风险显著增加。由于早期鼻部症状不明显,多学科协作诊疗十分必要。一旦影像学检查提示鼻窦病变所致眶尖综合征,应尽早行内镜鼻窦开放术。