儿童眶周及眶蜂窝织炎的临床研究

发布时间：2019-01-24 19:56

【摘要】：目的：探讨儿童眶周及眶蜂窝织炎(Children periorbital and orbital cellulitis)的临床特征、影像学检查特点及治疗。方法：对吉大二院眼科医院2007年1月至2012年1月收治的13例眶周和眼眶蜂窝织炎患儿的临床资料进行回顾性研究。总结临床特征、影像学检查特点及治疗。临床特征包括：视力、眼压、眼球突出度、眼球位置、运动情况、复像、眼前段及眼底脉络膜视网膜情况。影像学检查包括B型超声(brightness mode,B超)、计算机体层摄影(computed tomography CT)、磁共振成像(Magnetic resonance imaging, MRI)。早期全程足量应用广谱抗生素,必要时应用激素冲击治疗,鼻内镜下副鼻窦开放引流术是目前眶周及眶蜂窝织炎最有效的治疗方法。结果：眶周及眶蜂窝织炎视力下降者4例；患侧眼压异常5例；眼球突出度患侧眼相比明显突出者9例；良性上皮性肿瘤中,患者中4人不能配合眼球运动检查。眼球运动受限：1例患者出现上转受限,6例患者向各方向运动均受限,2例患者无运动受限,矫正视力大于0.3且能配合复像检查的患者,均行复像检查,5人存在复视；眼部疼痛12例,球结膜水肿7例,眼底改变1例。眶周及眶蜂窝织炎影像学表现：B超表现：3例表现为病变区软组织肿胀,边界不清,内部呈弥漫非均质性回声减弱区,肌肉条纹增亮,模糊或不显示,多伴有团絮状稍强回声。1例表现为在炎性病变区内的软组织中,即有实体性强回声,又有液化区无回声。CT表现：本研究中病灶分布：上壁3例,内壁3例,下壁5例,骨膜下间隙感染2例。7例患者出现明显的眼球移位,按照炎症累及的范围可分为肌锥内、肌锥外、骨膜下、巩膜下及弥漫性感染。其中肌锥内感染3例,2例出现脓肿占位效应,肌锥内间隙脓肿形成,显示球后圆形软组织密度影,密度均匀,边界清楚,CT平扫呈低密度,边界尚清,压迫视神经移位,1例注射对比剂后增强CT扫描,病灶周边呈现强化。肌椎外感染3例,表现为条形、片状软组织密度,眼直肌增粗,轮廓不清。骨膜下感染2例,表现为椭圆形或梭形软组织密度影。弥漫性感染5例,表现为眶隔前间隙、肌锥内外间隙正常结构间界面消失,视神经视不清,眼球突出,眼球移位,脂肪间隙内软组织密度影。MRI表现：本研究中1例患者行MRI检查,MRI显示脓肿在T1W1上显示中低信号,T2W1呈中高信号,病变不增强。眶周及眶蜂窝织炎的治疗：本组中全部13位患者入院后全程给予广谱抗生素(头孢替唑,每天每公斤体重100mg静脉滴注,根据患者症状,3例患者合并给予甲强龙冲击治疗,甲强龙每天每公斤体重1mg静脉滴注),患眼给予抗炎眼药水治疗。其中7位患者因脓肿形成同时给予鼻内镜下副鼻窦开放术治疗,2位患者因形成的脓肿灶表浅而行皮肤切口引流术。术中提取的脓液均给予微生物培养及药敏试验。9位患者脓液中,7例未培养出细菌生长,1例为表皮葡萄球菌,1例为金黄色葡萄球菌。1例患者就诊时即出现感染性休克,表现为精神抑郁淡漠,皮肤苍白,脉搏细速,入院后立即给予抗休克对症治疗。结论：眶周及眶蜂窝织炎具有比较典型的临床特征,可通过临床特征进行初步诊断。B超,CT,MRI对眶周及眶蜂窝织炎的鉴别诊断有重要价值。早期全程足量应用广谱抗生素,必要时应用激素冲击治疗,鼻内镜下副鼻窦开放引流术是目前眶周及眶蜂窝织炎最有效的治疗方法。
[Abstract]:Objective: To study the clinical features, imaging features and treatment of children's orbital and orbital cellulitis. Methods: The clinical data of 13 cases of periorbital and orbital cellulitis from January 2007 to January 2012 were retrospectively analyzed. To summarize the clinical features, features and treatment of image examination Therapy. Clinical features include vision, intraocular pressure, eye protrusion, eye position, motion, complex image, anterior segment, and fundus choroidal retinal condition. State. The imaging examination includes B-type ultrasound, B-mode ultrasound, computer tomography (CT), magnetic resonance imaging (MRI), and MRI.). In the early stage, a wide range of broad-spectrum antibiotics are applied, and if necessary, hormone-impact therapy is applied, and the subnasal open-flow operation under the nasal endoscope is the most effective treatment party for the periorbital and orbital cellulitis. Methods: 4 cases of visual acuity of periorbital and orbital cellulitis, 5 cases of ocular hypertension, 9 cases of eye protrusion, 9 cases of eye protrusion, and 4 in benign epithelial tumors, 4 of the patients were unable to cooperate with the eye movement. Dynamic examination. The movement of the eye was limited: 1 case had limited rotation, 6 cases were restricted in all directions, 2 patients had no movement limitation, corrected vision was more than 0.3, and the patients with complex image examination were able to be matched with the complex image examination, 5 had diplopia, 12 cases of ocular pain, and water of the conjunctiva of the ball. 7 cases of swelling and fundus changes The imaging performance of the periorbital and orbital cellulitis: B-mode ultrasound showed: 3 cases showed swelling of soft tissue in the lesion area, the boundary was not clear, the interior was in the diffuse non-homogeneous echo-weakened area, the muscle stripe increased and the model in that soft tissue area of the inflammatory lesion, i. e., there is a strong echo and a liquid. The results showed that there were 3 cases of upper wall, 3 cases of inner wall, 5 cases of lower wall and 2 cases of subperiosteal clearance infection. There were 3 cases of intrapyramidal infection, 2 cases of abscess-occupying effect, and the formation of intrapyramidal space abscess. The density and density of the circular soft tissues after the ball were displayed, the density was uniform, the boundary was clear, the CT level was low, the boundary was still clear, the optic nerve was compressed, and 1 case was increased after the injection of the contrast agent. Strong CT scan, week of focus There were 3 cases of extramuscular infection, which were in the form of bar, sheet-like soft tissue density, and thickening of the direct muscle of the eye. 2 cases of subperiosteum infection, with elliptic or shuttle-shaped soft tissue Tissue density shadow. In 5 cases of diffuse infection, the interface between the internal and external gaps of the muscle cone disappeared, the optic nerve was not clear, the eyeball is prominent, the eyeball is displaced, and the soft tissue is soft in the fat gap. Tissue density shadow. MRI findings: 1 patient in the study underwent MRI examination, and the MRI showed a low signal in the display of the abscess on T1W1 and a high signal in T2W1. The treatment of periorbital and orbital cellulitis: All 13 patients in this group were given broad-spectrum antibiotics (Ceftifloxacin, 100 mg per kg of body weight per kg of body weight per day), and 3 patients were given concomitant administration according to the symptoms of the patient. A high-strength dragon is treated with a long-term effect of 1 mg/ kg of body weight per kg of body weight, and the eye is given an eye. The treatment of anti-inflammatory eye drops. 7 of the patients were treated with a nasal endoscope under the nasal endoscope while the abscess was formed in 7 patients, and 2 patients were in the form of an abscess with a shallow table. There were no bacterial growth, 1 case of Staphylococcus epidermidis, 1 case of Staphylococcus aureus, 1 case of Staphylococcus aureus, 1 case of Staphylococcus aureus, 1 case of Staphylococcus aureus and 1 case of Staphylococcus aureus. The apathy, the skin is pale, the pulse is fine, the admission is given immediately Conclusion: The periorbital and orbital cellulitis are of typical clinical characteristics and can be applied to the treatment of shock. The characteristics of the bed were initially diagnosed. B-ultrasound, CT, MRI were used to treat periorbital and orbital cellulitis. It is of great value to identify and diagnose. In the early period, a wide range of broad-spectrum antibiotics were applied, and hormone-impact therapy was applied in the early stage.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R777.5

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