摘要
目的:探讨儿童鼻部疾病引起鼻源性眶内并发症的临床特点、影像、诊断及治疗。方法:回顾性分析2019—2023年温州医科大学附属第二医院育英儿童医院耳鼻咽喉科收住的7例鼻源性眶内并发症患儿的完整临床资料,根据相关病史、体格检查、影像学资料等了解该病的临床特点及诊治方法,并回顾相关文献。结果:本组7例患儿中6例因急性鼻窦炎引起眶并发症,1例则因鼻前庭炎、鼻疖引发眶内及眶周病变。本组患儿临床表现均有眼周红肿、疼痛、眼球及眼睑活动受限等表现,其中患有急性鼻窦炎的5例患儿均有发热,最高体温38~40℃,部分伴咳嗽、头痛、鼻塞流涕。CT示:眼睑和眶周软组织肿胀,眶内结构清晰(3例);眶内结构边缘模糊、正常结构消失,眶间隙密度局限或弥漫性增高,眼球突出程度不等,内直肌影增粗(4例)。入院后本组所有病例均予抗生素、糖皮质激素抗炎、质子泵抑制剂护胃及降温补液等对症治疗,其中1例鼻前庭炎、鼻疖患儿行鼻疖切排术后予上述药物,1例鼻窦炎并眶蜂窝织炎患者保守治疗无效后行鼻内镜术。在住院3~13 d后本组患儿均治愈出院。结论:人体鼻腔鼻窦与眼眶结构相邻,且儿童机体结构仍处在发育阶段,故鼻病在儿童更易侵犯眶组织,若不及时诊治将走向严重后果。该病治疗原则上早期应积极行抗感染、抗炎治疗及通畅引流,必要时需行鼻窦开放术、眶减压术,请眼科医师协同处理。对于儿童患者来说,其诊治重心在于预防疾病的进展,防止造成永久性视力丧失和颅内并发症的发生。
Objective:To explore the clinical characteristics,imaging,diagnosis and treatment of nasal intraorbital complications caused by nasal diseases in children.Methods:Clinical data of 7 children with nasogenic intraorbital complications admitted to the Second Affiliated Hospital&Yuying Children’s Hospital of Wenzhou Medical University from 2019 to 2023 were retrospectively analyzed.The clinical characteristics,diagnosis and treatment of the disease were investigated according to relevant medical history,physical examination and imaging data and the literature reviewed.Results:Of the 7 cases,6 had orbital complications due to acute sinusitis,and 1 case had intraorbital and periorbital lesions due to nasal vestibulitis and nasal furuncle.The clinical manifestations of children in this group included redness and swelling around the eyes,pain,limited movement of eyeballs and eyelids,etc.Among them,5 children with acute sinusitis had fever with the highest body temperature of 38-40℃,some accompanied by cough,headache,nasal congestion and runny nose.CT showed swelling of eyelid and periorbital soft tissue,and clear intraorbital structure in 3 cases and in 4 cases were found blurred edge of the orbital structure,disappearance of the normal structure,limited density or increased diffusion of the orbital space the varied degree of exophthalmosis and the thickened shadow of the internal rectus muscle.After admission,all the patients in this group were given symptomatic treatment such as antibiotics,glucocorticoid anti-inflammatory,proton pump inhibitor to preserve the stomach and cooling fluid,etc.Among them,1 patient with rhinocorticoid and nasal furuncle was given the above drugs after the operation of nasal furuncle,and 1 patient with nasosinusitis and orbital cellulitis was given nasal endoscopy after conservative treatment failed.All the children were cured and discharged from hospital after 3-13 days of hospitalization.Conclusion:The nasal cavity and sinuses in the human body are adjacent to the orbital structures,and in children,whose bodies are still in the developmental stage,nasal diseases are more likely to invade orbital tissues.Unless diagnosed and treated promptly,it can lead to serious consequences.In principle,early anti-infection and anti-inflammatory therapy and unobstructed drainage should be initiated.If necessary,sinusotomy or orbital decompression surgery may be performed with the collaboration of ophthalmologists.For pediatric patients,the diagnosis and treatment should be focused on the prevention of disease progression,permanent visual loss and intracranial complications.
作者
施晨洁
陈波蓓
SHI Chenjie;CHEN Bobei(Department of Otorhinolaryngology,the Second Affiliated Hospital&Yuying Children’s Hospital of Wenzhou Medical University,Wenzhou 325027,China)
出处
《温州医科大学学报》
CAS
2024年第2期151-155,共5页
Journal of Wenzhou Medical University
关键词
鼻部疾病
鼻源性眶内并发症
体层摄影术
X线计算机
诊断
鼻疖切排术
nasal disease
intranasal orbital complications
tomography,X-ray computed
diagnosis
excision of nasal furuncles
