CAJ | 학술논문

目的总结鼻内镜鼻窦手术导致严重眼眶并发症的临床特征.方法回顾性系列病例研究.收集2002年1月至2012年12月在武警总医院眼眶病研究所诊治的22例鼻内镜鼻窦手术导致严重眼眶并发症患者的临床资料,记录鼻科病史、眼眶并发症的临床表现及影像学特征,记录眶内损伤的部位,分析损伤与临床表现的关系.结果 22例患者的严重并发症包括视力丧失7例(32％),上睑下垂5例(23％),眼位偏斜15例(68％),眼球运动受限17例(77％),眼球凹陷10例(45％)等.影像学显示内直肌受累14例(64％),下直肌受累6例(27％);手术误人眼眶最常见的途径是内壁14例(64％),其次是内下壁6例(27％);视神经内侧移位7例(32％);眶内或鼻窦内异物8例(36％).保守治疗1例,手术治疗9例,其中6例取出眶内异物,1例修补下直肌并修复眶壁缺损,术后眼球运动无改善,2例行眼球凹陷矫正手术,1例术后改善,1例无效.结论鼻内镜鼻窦手术导致的严重眼眶并发症中,以视力丧失危害最大,眼球运动受限和眼位偏斜为最常见临床表现.损伤部位以内直肌最为常见,常伴内壁骨缺损.除异物外,其他并发症治疗困难,预后差,应注重预防.
목적 총결비내경비두수술도치엄중안광병발증적림상특정.방법 회고성계렬병례연구.수집2002년1월지2012년12월재무경총의원안광병연구소진치적22례비내경비두수술도치엄중안광병발증환자적림상자료,기록비과병사、안광병발증적림상표현급영상학특정,기록광내손상적부위,분석손상여림상표현적관계.결과 22례환자적엄중병발증포괄시력상실7례(32％),상검하수5례(23％),안위편사15례(68％),안구운동수한17례(77％),안구요함10례(45％)등.영상학현시내직기수루14례(64％),하직기수루6례(27％);수술오인안광최상견적도경시내벽14례(64％),기차시내하벽6례(27％);시신경내측이위7례(32％);광내혹비두내이물8례(36％).보수치료1례,수술치료9례,기중6례취출광내이물,1례수보하직기병수복광벽결손,술후안구운동무개선,2례행안구요함교정수술,1례술후개선,1례무효.결론 비내경비두수술도치적엄중안광병발증중,이시력상실위해최대,안구운동수한화안위편사위최상견림상표현.손상부위이내직기최위상견,상반내벽골결손.제이물외,기타병발증치료곤난,예후차,응주중예방.
Objective To summarize the clinical feature of severe orbital complications after endoscopic sinus surgery and to explore the precautions.Methods A retrospective review study.Twentytwo cases of severe orbital complications after endoscopic sinus surgery between January 2002 and December 2012 were included.The main parameters for analyzing were history of paranasal sinuses,clinical manifestation of complications,imaging findings,site of injury,the relationship between injury site and clinical signs.Results Twenty-two cases of patients with serious complications,including:visual loss in 7 cases (32％),ptosis in 5 cases (23％),ocular position deviation in 15 cases (68％),limitation of ocular motility in 17 cases (77％),enophthalmos in 10 cases (45％).Imaging display:medial rectus involvement in 14 cases,inferior rectus involvement in 6 cases.The most common site of entry into the orbit was the medial orbital wall (14 cases,64％),followed by the inferomedial wall (6 cases,27％).Radiological imagings showed the medial displacement of optic nerve in 7 cases (32％) and foreign bodies in the orbit or paranasal sinuses in 8 cases (36％).Medical treatment was given in 1 cases and surgical repair in 9 cases.Removal of foreign bodies was performed in 6 cases.One patient received inferior rectus and orbital wall repair,but no improvement in ocular movement.Orbital reconstruction for endophthalmos was performed in two cases.The improvement was recorded only in one case.Conclusions The most severe complication is vision loss and the most common complication is limitation of ocular motility and ocular position deviation.The most common site of injury was within the rectus muscle,often accompanied by the defect of inner wall.Except foreign bodies,other complications were difficult to treat with poor prognosis.Emphasis should be placed on prevention.