鼻内镜鼻窦手术致严重眼眶并发症的临床分析

摘要

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.%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.