- 期刊
Lynch Incision for Postoperative Periorbital Hemorrhage
Lynch切開術治療術後眼周邊出血
摘要
Orbital complications of functional endoscopic sinus surgery (FESS) are rare with an incidence of 0.3%. The standard clinical management of periorbital hematoma includes a complete ophthalmologic examination, consultation with an ophthalmologist, medical therapy, removal of redundant nasal packing, orbital massage, canthotomies, cantholysis, and, in severe cases, ligation of the bleeding vessels. A 58-year-old female diagnosed with chronic rhinosinusitis underwent FESS, but left periorbital ecchymosis was noted after surgery. As the symptoms worsened despite conservative therapy, the Lynch incision procedure was arranged to investigate the bleeding and decrease intraocular pressure (IOP). The primary objective in treating post-FESS periorbital hemorrhage is to decrease IOP to prevent damage to the orbital nerve. Lateral cantholysis-canthotomy is the most frequently performed surgical intervention for this purpose. However, Lynch incision was used in this case to treat post-FESS periorbital hemorrhage through decompression and ligation of the bleeding vessel.
並列摘要
功能性內視鏡鼻竇手術（Functional Endoscopic Sinus Surgery, FESS）導致眼睛相關的併發症發生率大約為0.3%。功能性內視鏡鼻竇手術造成的眼睛周邊出血，常見處理方式為藥物治療、眼框按摩、移除鼻內多餘的填塞物、眼角切開術（Canthotomy）、眼角離斷術（cantholysis），甚至將出血的血管結紮。1名58歲女性，因為慢性鼻竇炎，接受雙側功能性內視鏡鼻竇手術。術後當天晚上在左眼角處出現瘀青，術後第二天，左眼瘀青的範圍持續擴大，且眼睛逐漸難以張開，因此會診眼科，此時量測的眼壓為25 mmHg。並且再次進入刀房，用鼻內視鏡以及Lynch切開術，確認出血處以及幫病人眼睛減壓。在術中發現左邊篩竇持續出血，使用Lynch切開術止血並確認沒有出血持續流向眼周後，放一條Penrose引流多餘的血水。術後病人恢復良好，眼壓回到16 mmHg。針對FESS造成的眼睛周邊出血，治療首要目標為降低眼壓以免傷到視神經，常見的治療方式以眼角切開術及眼角離斷術為主，本次案例有別以往採用Lynch切開術，假如病人出血較嚴重，使用Lynch切開術除了可以降低眼壓還可以將出血的血管結紮，可謂一舉兩得。