【摘要】 目的探讨鼻内镜手术筛前动脉损伤所致眶内并发症的原因分析、处理及预防。方法分析2例鼻内镜手术筛前动脉损伤所致眶内并发症的临床特点、处理方法及预后,进行相关文献复习,分析筛前动脉损伤的高危因素及预防措施。结果 2例患者术后均出现眶压增高、球结膜水肿、视力下降,考虑为筛前动脉损伤致眶内血肿,经过及时行眶减压、电凝止血,一例患者术后视力逐渐恢复正常,另一例患者视力未能得到有效恢复。结论鼻内镜术前需仔细阅片,对于筛前动脉游离度大的病例,以及肿瘤破坏骨质包裹动脉的患者,术中需注意仔细辨认,避免损伤筛前动脉;如术中动脉损伤应及时电凝止血;术后出现眶压增高、视力明显下降者,应考虑筛前动脉损伤导致眶内血肿可能,应及时进行眶减压及筛前动脉电凝止血。更多还原

【Abstract】 Objective To investigate the treatment and prevention of intraorbital complications caused by anterior ethmoidal artery(AEA) injury endoscopic sinus surgery(ESS).Methods The clinical characteristics, treatment and prognosis of 2 case of intraorbital complications caused by AEA injury in ESS were analyzed retrospectively. The high-risk factors and preventive measures of AEA injury in ESS were summarized with review of literatures.Results Postoperative increased intraorbital pressure, chemosis and impaired vision occurred in both patients. All the symptoms were considered to be caused by intraorbital hematoma due to intraoperative injury of the AEA. After timely orbital decompression and AEA electrocoagulation, vision of one patient gradually returned to normal, while that of the other patient could not be effectively restored.Conclusions Careful evaluation of computerized tomography(CT) imagines is recommended before ESS. For patients with high freeness of AEA, or with destroyed bone and wrapping AEA by tumor, cautious identification of AEA is required intraoperatively to avoid AEA injury. In case of intraoperative arterial injury, timely hemostasis should be performed. The possibility of intraorbital hematoma caused by AEA injury should be considered in patients with postoperative increase of orbital pressure and dramatic decrease of visual acuity, and orbital decompression as well as electrocoagulation of the AEA should be performed timely.更多还原