儿童眶周和眼眶蜂窝织炎的临床分析

目的:探讨儿童眶周和眼眶蜂窝织炎的临床特点及治疗方法。方法:对2010年本院收治的54例眶周和眼眶蜂窝织炎患儿的临床资料进行回顾性研究。结果:儿童眶周蜂窝织炎34例,眼眶蜂窝织炎20例,平均男女比例2.6∶1,3岁以下发病比例达71%。两者发病季节高峰分别在11月份和1月份,发病原因多样化。眶周蜂窝织炎的外周血白细胞计数、中性粒细胞计数及血清C反应蛋白(CRP)升高比例低于眼眶蜂窝织炎,差异有统计学意义(P<0.01)。57%眶周蜂窝织炎和88%眼眶蜂窝织炎患儿CT检出鼻窦炎。眼部脓肿的脓液培养得到金黄色葡萄球菌、模仿葡萄球菌和肺炎链球菌。眶周蜂窝织炎可用单一或二联抗生素治疗,眼眶蜂窝织炎常需抗生素联合用药,必要时实行手术。结论:儿童眶周蜂窝织炎和眼眶蜂窝织炎的发病年龄集中在3岁以下,秋冬季为高发季节,上呼吸道感染和鼻窦炎是主要病因。眼眶蜂窝织炎比眶周蜂窝织炎感染重,CT有利于临床诊断,抗生素应覆盖葡萄球菌和链球菌,并根据病因和微生物学检查调整用药,在适宜时期实行手术可以加快治愈并减少复发。     

儿童重症眼眶蜂窝织炎病因分析

目的探讨儿童重症眶蜂窝组织炎的致病因素。方法对深圳市儿童医院2008年1月至2012年6月住院的53例(53只眼)儿童重症眼眶蜂窝织炎病例资料进行回顾性研究。结果儿童重症眼眶蜂窝织炎好发于5月及11月;外周血白细胞计数及血清C反应蛋白平均值分别为(19.2±3.9)×109/L和(54.2±6.1)mg/L;血培养、脓液或分泌物均显示金黄色葡萄球菌是最常见致病菌;鼻窦炎(52.8%)和上呼吸道感染(26.4%)是儿童重症眼眶蜂窝织炎的最主要致病原因。结论了解儿童重症眼眶蜂窝织炎的常见病因,针对病因治疗可以有效的提高该病的疗效及预后。     

眶蜂窝织炎9例治疗分析

眶蜂窝织炎９例治疗分析河南省舞钢市人民医院李敏，余秋玲眶蜂窝织炎为严重的眼眶软组织炎症，它不仅危害视力，有时尚可造成对生命的威胁．炎症反应引起的眼球突出可引起暴露性角膜炎，炎症进展迅速，毒性产物被吸收可引起全身中毒，向后蔓延至颅内可引起海绵窦栓塞、脑...     

眶蜂窝织炎治疗效果的临床观察

目的：探讨眶蜂窝织炎的发病特点、诊断方法及治疗原则,观察局部对因治疗配合全身综合治疗的临床疗效,为临床诊断和治疗提供理论依据。 方法：对63例眶蜂窝织炎患者的诊断及治疗进行观察和分析。 结果：全部的患者均得到较好的疗效,在2wk~1mo内痊愈,无严重的并发症发生。 结论：眶蜂窝织炎在明确诊断后,通过积极对因治疗、全身抗炎及支持治疗,将减轻患者痛苦,缩短病程,减少并发症的发生。     

眼眶颞下窝脓肿鼻内窥镜下切开引流术一例

1病例患者：男,55岁。因眼胀、头昏头痛伴眼球突出、视物模糊2月于2007年9月2日入院。2月前出现鼻塞、流脓鼻涕、前额闷痛、右眼胀痛,并逐渐出现眼球突出,视物模糊,无明显呕吐现象。在本地眼睑切开引流治疗后,症状有所缓解,但停止治疗后症状反复发作、     

97例儿童眶蜂窝织炎的诊治及疗效

目的 回顾性分析和总结儿童眶蜂窝织炎的临床特征、诊治经验,并观察临床疗效。设计 回顾性病例系列。研究对象 北京儿童医院收治的连续儿童眶蜂窝织炎患儿97例（106眼）。年龄为生后7天~11岁,平均年龄（11±9）个月。方法 对所有患儿的病历资料进行回顾性分析,包括血常规、C反应蛋白（CRP）、血培养及药敏培养检查、眼眶及鼻窦CT影像特点等,大于4岁能配合的患儿检查视力、眼位、眼前段、眼底等。所有患眼使用抗生素点眼,口服或静脉滴注抗生素。切开排脓指征：（1）明确诊断眶隔前蜂窝织炎;（2）血白细胞计数（WBC）及CRP明显高于正常;（3）抗生素控制感染效果不佳;（4）患眼肿胀,明确触及脓肿处有波动感;（5）有眼眶CT的支持。所有切开排脓的患者均取脓液进行常规细菌培养。观察分析患儿的临床表现、实验室检查指标及疗效。主要指标 临床表现、WBC、CRP、疗效、病原学检查及并发症。结果 74例（76%）患儿年龄小于3岁,其中23例发病于出生后1个月内。单纯眶隔前蜂窝织炎71眼（67%）,眶蜂窝织炎35眼（33%）。有切开排脓指征的63眼（59%）患儿在全身使用抗生素下,行切开排脓引流术。术后次日血WBC由术前（23.6±9.1）×109/L降至（16.3±5.1）×109/L;CRP由术前（52±17）mg/L降至（37±12）mg/L;体温由术前（38.8±1.4）°C降至（38.2±0.4）°C。术后7~10天逐渐拔除引流条后感染症状完全控制。细菌培养结果：金黄色葡萄球菌感染者（81%）最多。最常见的并发症是球结膜脱垂及暴露性角膜炎（29例,27%）。结论 眶蜂窝织炎多发生于婴幼儿。全身使用抗生素,必要时切开排脓是治疗的关键。     

儿童眼眶蜂窝织炎

眶蜂窝织炎是发生于眼眶软组织内的急性化脓性炎症,可引起永久性视力丧失,并通过颅内蔓延,造成败血症危及生命[1-3]。该病主要侵犯儿童,一般较轻的眶蜂窝织炎的感染都是因为虫咬、外伤以及结膜炎所致,最常见的是鼻窦、筛窦的炎症弥漫所致[4]。因此需要迅速的诊断、检查以及治疗。熟悉眼眶以及毗邻的解剖是诊断以及治疗的要点。现就诊断、治疗等综述如下。     

糖尿病并发眶蜂窝织炎1例

患者　男　 43岁　左眼红肿、疼痛 2 4天 ,加重 3天入院。 2 4天前 ,患者不明原因的出现左眼红肿、疼痛、视力渐下降等症状 ,未引起足够的重视 ,亦未进行治疗。 8天前 ,上述症状加重 ,在当地医院治疗 ,诊断为左眼眶蜂窝织炎。局部用抗生素点眼、全身用抗生素静点。左眼红肿、疼痛不见好转 ,视力进行性下降 ,但全身无发热。 2次查血Ｒｔ ,未见ＷＢＣ升高。故于 2 0 0 1年 12月 2 0日住我院治疗。查体 :Ｔ :36 5℃ ,Ｐ :76次 /ｍｉｎ ,Ｒ :2 0次 /ｍｉｎ ,Ｂｐ :115 / 75ｍｍＨｇ。发育正常 ,营养中等 ,痛苦面容 ,自动体位 ,神志清 ,头颈部淋…     

儿童眼眶蜂窝织炎（续）

2.多层螺旋CT多平面重组（MPR）[11]：最常用的是冠状位和矢状位的重组,显示眶上下壁骨膜下脓肿向眶内突出的程度及受侵的大小范围,眼外肌、视神经、眼球的受压及眶壁受累情况,尤其对范围较小的眶上下壁脓肿。     

Management of preseptal and orbital cellulitis

Orbital cellulitis describes an infection involving the soft tissues posterior to the orbital septum, including the fat and muscle within the bony orbit. This condition may be associated with severe sight and life-threatening complications. Despite significant advances in antimicrobial therapies and diagnostic technologies, the management of orbital cellulitis often remains challenging, and rapid diagnosis and prompt initiation of therapy are important in minimizing complications and optimizing outcomes. This review summarizes the distinctive characteristics of preseptal and orbital cellulitis, with a focus on anatomic considerations, predisposing conditions, approaches to evaluation, and management strategies.     

眶蜂窝织炎63例分析

目的 探讨眶蜂窝织炎的致病原因、致病菌及并发症.方法 回顾性病例系列研究.回顾性分析西京医院自1960年至2008年收治的63例眶蜂窝织炎住院患者的临床资料,对其性别、年龄、致病途径、致病菌及并发症进行分析.结果 63例患者中,男性48例（76.2%）,女性15例（23.8%）;10岁以下年龄组患者较多（22例,34.9%）;单眼发病多见（61例,96.8%）;32例（50.8%）患者伴有明显眼球突出.致病途径以周围组织炎症蔓延最多见（47.6%）,其他包括血行感染（19.0%）、眼部外伤（15.9%）和眼部手术后并发感染（3.2%）.30例患者进行了细菌培养,仅18例（60.0%）细菌培养为阳性.致病菌有4类,以葡萄球菌属最为多见（14例,77.8%）,尤以金黄色葡萄球菌为主（8例,44.4%）,此外还有绿脓杆菌（11.1%）、甲型溶血性链球菌（5.6%）和中间型弗氏枸橼酸杆菌（5.6%）.本组有19例（30.1%）发生并发症,包括败血症（12.7%）、暴露性角膜炎（4.8%）、全眼球炎（4.8%）、化脓性脑膜炎（4.8%）和海绵窦栓塞性静脉炎（3.2%）等.结论 眶蜂窝织炎多见于10岁以下儿童患者,以单眼眼球突出为主要表现,致病途径以眶周组织结构感染蔓延为主.细菌培养阳性率较低,以金黄色葡萄球菌为主要致病菌.本病可发生严重并发症,宜早期积极给予广谱抗生素治疗,如脓肿形成应及时切开引流.     

Bacterial periorbital and orbital cellulitis in childhood

The clinical features, microbiologic data, complications, and treatment in 137 children with periorbital cellulitis and 21 children with orbital cellulitis is presented. Periorbital cellulitis was more frequent (87%) than orbital cellulitis (13%). Periorbital cellulitis is a heterogeneous disease that may complicate trauma of the eyelids, external ocular infection, and upper respiratory infection. Children with periorbital cellulitis related to trauma or external infection tended to be less than 5 years old with negative blood cultures (99%) and positive cultures of percutaneous aspirates (42%); while children with periorbital cellulitis related to upper respiratory infection also tended to be less than 5 years of age, but blood cultures were frequently positive (42%) and cultures of percutaneous aspirates were usually negative (92%). Three children in the latter group developed meningitis. Intravenous antibiotic alone was effective treatment in most patients (90%). Orbital cellulitis was more frequent in children older than 5 years and frequently associated with sinusitis (90%). Blood and skin cultures were usually negative. Intravenous antibiotics alone were effective management in many patients (62%), but a significant proportion required paranasal sinus or orbital surgery (38%).     

视神经损伤鼻内窥镜下视神经管减压术

目的 分析间接性视神经损伤的特点以及鼻内窥镜下视神经管减压术的手术方法。方法 介绍1998－1999年我院施行鼻内窥镜下视神经管减压术6例（6眼），比较手术前后的视力、瞳孔变化。结果 6例术后均维持和提高视力，肯定鼻内窥镜下视神经管减压术能改善间接损伤的视神经功能。结论 鼻内窥镜下视神经管减压术优于其他手术进路的视神经管减压术，避免诸多并发症及其危险。     

鼻内镜下取自体骨个体化治疗眶内侧壁骨折疗效分析△

目的 探讨鼻内镜下经筛窦入路利用自体骨行个体化重建眶内侧壁的疗效。方法 采用鼻内镜下经鼻-鼻窦入路,根据患者眶内侧缺损大小及鼻中隔形态,行个体化重建眶内侧壁治疗16例,观察患者术后眼球运动障碍、眼球凹陷、复视症状恢复情况。结果 本组16 例患者术后随访3~13个月,眼球运动障碍、眼球凹陷、复视基本恢复,未出现鼻中隔血肿及穿孔、眶内感染、视力下降、移植骨片脱位等并发症,仅1例患者在术后第5天因不慎挖鼻后反复出现鼻出血行鼻内镜下电凝止血术。结论 经鼻内镜下鼻窦入路,利用自体鼻中隔软骨及筛骨垂直板个体化重建眼眶内侧壁,疗效较确切。     

Clinical and microbiologic features of dacryocystitis-related orbital cellulitis

Dacryocystitis-related orbital cellulitis is a relatively rare condition, and large case series of this clinical entity have been reported. This study was undertaken to identify a larger cohort of patients with this ailment, with the intent of defining its clinical and microbiologic features. Case logs from four institutions were reviewed to identify patients that suffered from dacryocystitis-related orbital cellulitis. A retrospective chart review was then performed to identify clinical features, management strategies, microbiologic features, and outcomes. A dedicated statistical software package was utilized to identify correlations between these variables. 13 patients (7 females, 6 males; mean age = 57.2 years, range = 7–89 years) were identified. One patient carried a diagnosis of immunosuppressive disease. All patients underwent emergent surgical drainage and received intravenous antibiotics. Primary acquired nasolacrimal duct obstruction was found to be the underlying etiology in nine cases (69.2%), whereas four patients suffered from specific causes of their obstructions. An average of 1.07 organisms/patient (standard deviation = 0.49 organisms/patient) were recovered from microbiologic cultures, and Gram-positive bacteria represented the majority of cultured organisms. All patients experienced either stable or improved vision upon discharge. The relationships between a specific etiology and the possibility of vision loss or the number of organisms cultured, between the number of organisms cultured and vision loss, and immunosuppression and vision loss or the number of organisms cultured were all not statistically significant (p > 0.05). Dacryocystitis-related orbital cellulitis most commonly occurs in adult patients who do not carry immunosuppressive diagnoses and suffer from primary obstructions. Multiple microbiologic species may cause this problem, although Gram-positive organisms are most common. With appropriate management, stable or improved vision can be achieved.     

Severe aseptic orbital cellulitis with subtenon carboplatin for intraocular retinoblastoma

Retinoblastoma is a rare intraocular tumor of childhood. Chemoreduction followed by laser or cryotherapy is the treatment of choice. Subtenon carboplatin injection is also an accepted treatment modality for vitreous seeds, along with systemic chemotherapy. Transient periocular edema, optic neuropathy and fibrosis of orbital tissues are the known side effects of subteneon carboplatin injection. We report a case of severe aseptic orbital cellulitis with necrosis and prolapse of the conjunctiva 48 h after the injection, which resolved well on only conservative management.     

一种新型泪道支架在鼻内镜下泪囊鼻腔吻合术中的应用

目的:观察鼻内窥镜下行泪囊鼻腔吻合术后,置入一种新型多功能泪道支架治疗鼻泪道阻塞的近期及中期疗效,并评价其临床应用价值。方法:回顾性系列病例研究。对76例79眼鼻泪道阻塞患者行泪囊鼻腔吻合术后,置入多功能泪道支架,术后2~3mo拔管,拔管后随访3~6mo。结果:患者79眼中,成功植入支架77眼,手术成功率为97.5%;术后2~3mo全部成功拔管,拔管后随访3~6mo;不溢泪、泪道冲洗畅通60眼;溢泪症状改善、泪道冲洗部分返流15眼,总有效率为97.4%,2眼未愈;术后未发生支架移位脱落等并发症,吻合口均上皮化良好。结论:该多功能泪道支架具有手术方法简单快捷、并发症少、恢复快等优点,能大大提高鼻内镜下泪囊鼻腔吻合术的成功率和适用范围,是一种安全、有效治疗鼻泪道阻塞的新方法。