兒童眶周及眶蜂窩織炎的臨床研究
發(fā)布時(shí)間：2019-01-24 19:56
【摘要】：目的：探討兒童眶周及眶蜂窩織炎(Children periorbital and orbital cellulitis)的臨床特征、影像學(xué)檢查特點(diǎn)及治療。 方法：對吉大二院眼科醫(yī)院2007年1月至2012年1月收治的13例眶周和眼眶蜂窩織炎患兒的臨床資料進(jìn)行回顧性研究�？偨Y(jié)臨床特征、影像學(xué)檢查特點(diǎn)及治療。臨床特征包括：視力、眼壓、眼球突出度、眼球位置、運(yùn)動(dòng)情況、復(fù)像、眼前段及眼底脈絡(luò)膜視網(wǎng)膜情況。影像學(xué)檢查包括B型超聲(brightness mode,B超)、計(jì)算機(jī)體層攝影(computed tomography CT)、磁共振成像(Magnetic resonance imaging, MRI)。早期全程足量應(yīng)用廣譜抗生素,必要時(shí)應(yīng)用激素沖擊治療,鼻內(nèi)鏡下副鼻竇開放引流術(shù)是目前眶周及眶蜂窩織炎最有效的治療方法。 結(jié)果：眶周及眶蜂窩織炎視力下降者4例；患側(cè)眼壓異常5例；眼球突出度患側(cè)眼相比明顯突出者9例；良性上皮性腫瘤中,患者中4人不能配合眼球運(yùn)動(dòng)檢查。眼球運(yùn)動(dòng)受限：1例患者出現(xiàn)上轉(zhuǎn)受限,6例患者向各方向運(yùn)動(dòng)均受限,2例患者無運(yùn)動(dòng)受限,矯正視力大于0.3且能配合復(fù)像檢查的患者,均行復(fù)像檢查,5人存在復(fù)視；眼部疼痛12例,球結(jié)膜水腫7例,眼底改變1例。 眶周及眶蜂窩織炎影像學(xué)表現(xiàn)：B超表現(xiàn)：3例表現(xiàn)為病變區(qū)軟組織腫脹,邊界不清,內(nèi)部呈彌漫非均質(zhì)性回聲減弱區(qū),肌肉條紋增亮,模糊或不顯示,多伴有團(tuán)絮狀稍強(qiáng)回聲。1例表現(xiàn)為在炎性病變區(qū)內(nèi)的軟組織中,即有實(shí)體性強(qiáng)回聲,又有液化區(qū)無回聲。CT表現(xiàn)：本研究中病灶分布：上壁3例,內(nèi)壁3例,下壁5例,骨膜下間隙感染2例。7例患者出現(xiàn)明顯的眼球移位,按照炎癥累及的范圍可分為肌錐內(nèi)、肌錐外、骨膜下、鞏膜下及彌漫性感染。其中肌錐內(nèi)感染3例,2例出現(xiàn)膿腫占位效應(yīng),肌錐內(nèi)間隙膿腫形成,顯示球后圓形軟組織密度影,密度均勻,邊界清楚,CT平掃呈低密度,邊界尚清,壓迫視神經(jīng)移位,1例注射對比劑后增強(qiáng)CT掃描,病灶周邊呈現(xiàn)強(qiáng)化。肌椎外感染3例,表現(xiàn)為條形、片狀軟組織密度,眼直肌增粗,輪廓不清。骨膜下感染2例,表現(xiàn)為橢圓形或梭形軟組織密度影。彌漫性感染5例,表現(xiàn)為眶隔前間隙、肌錐內(nèi)外間隙正常結(jié)構(gòu)間界面消失,視神經(jīng)視不清,眼球突出,眼球移位,脂肪間隙內(nèi)軟組織密度影。MRI表現(xiàn)：本研究中1例患者行MRI檢查,MRI顯示膿腫在T1W1上顯示中低信號(hào),T2W1呈中高信號(hào),病變不增強(qiáng)。 眶周及眶蜂窩織炎的治療：本組中全部13位患者入院后全程給予廣譜抗生素(頭孢替唑,每天每公斤體重100mg靜脈滴注,根據(jù)患者癥狀,3例患者合并給予甲強(qiáng)龍沖擊治療,甲強(qiáng)龍每天每公斤體重1mg靜脈滴注),患眼給予抗炎眼藥水治療。其中7位患者因膿腫形成同時(shí)給予鼻內(nèi)鏡下副鼻竇開放術(shù)治療,2位患者因形成的膿腫灶表淺而行皮膚切口引流術(shù)。術(shù)中提取的膿液均給予微生物培養(yǎng)及藥敏試驗(yàn)。9位患者膿液中,7例未培養(yǎng)出細(xì)菌生長,1例為表皮葡萄球菌,1例為金黃色葡萄球菌。1例患者就診時(shí)即出現(xiàn)感染性休克,表現(xiàn)為精神抑郁淡漠,皮膚蒼白,脈搏細(xì)速,入院后立即給予抗休克對癥治療。 結(jié)論：眶周及眶蜂窩織炎具有比較典型的臨床特征,可通過臨床特征進(jìn)行初步診斷。B超,CT,MRI對眶周及眶蜂窩織炎的鑒別診斷有重要價(jià)值。早期全程足量應(yīng)用廣譜抗生素,必要時(shí)應(yīng)用激素沖擊治療,鼻內(nèi)鏡下副鼻竇開放引流術(shù)是目前眶周及眶蜂窩織炎最有效的治療方法。
[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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R777.5
本文編號(hào)：2414794
[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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R777.5
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