Paranasal Sinusitis Following Orbital Decompression in Patients with Graves' Ophthalmopathy

甲狀腺眼疾患者接受眼窩減壓術後產生副鼻竇炎之研究

李嵐(Lan Lee) ； 馬俐(Lih Ma) ； 吳淑雅(Shu-Ya Wu) ； 蔡悅如(Yueh-Ju Tsai)

《中華民國眼科醫學會雜誌》 45卷4期 (2006/12) Pp. 367-375

https://doi.org/10.30048/ACTASOS.200612.0003

摘要

目的：調查因甲狀腺眼疾而接受眼窩減壓術的病患，術後副鼻竇炎的發生率、治療方法及結果。
方法：本篇為一回溯性研究，調閱自1988年12月至2004年10月共144名接受眼窩減壓術病患的病歷及電話追蹤，我們施行的是經穹窿底側壁及經內眥內側壁及／或外側壁減壓術，若病患有任何和鼻竇炎相關的症狀，則請病患回診，安排電腦斷層及耳鼻喉科醫師的照會。
結果：94名持續追蹤的病患中，3名病患因術前即診斷有鼻竇炎而排除，在91位納入本次統計的病患中，11位(12.1%)確定診斷有鼻竇炎，其中8位(72.7%)病患的症狀經抗生素治療後改善，3位(27.3%)病患接受FESS手術。
結論：眼窩減壓術後鼻竇炎的發生率高於預期，最常見的原因為上頜竇開口被脫垂的眼窩內容物阻塞所導致，避免脫垂的眼窩內容物阻塞上頜竇開口，或在術中做一個中鼻甲造口，可以預防術後鼻竇炎的發生。

並列摘要

Purpose: To investigate the incidence, management, and outcome of paranasal sinusitis following orbital decompression in patients with Graves' ophthalmopathy.
Design: Retrospective review study.
Participants: A total of 144 patients received orbital decompression between December 1988 and October 2004. Ninety-four patients were available for follow up.
Methods: We reviewed the clinical records of all patients who underwent orbital decompression and used telephone interviews. The orbital decompression operation we performed was transfornicial floor and transcaruncular medial wall and/or lateral wall decompression. If a patient had any symptoms associated with sinusitis, we would ask the patient to return to the hospital to have computed tomography (CT) scan examination and an ENT consultation.
Results: Three patients were excluded because they had sinusitis before the decompression operation. Of the 91 remaining patients, 11 (12.1%) had definite diagnosis of sinusitis. Eight (72.7%) patients' symptoms subsided after antibiotics and 3 (27.3%) patients received FESS operation.
Conclusion: The number of patients with sinusitis was higher than anticipated. Occlusion of the maxillary sinus ostium by prolapsed orbital contents was the most common cause of post-decompression sinusitis. Preventing prolapsed orbital contents from obstructing the maxillary sinus ostium or performing a wide middle meatal antrostomy during the initial operation can prevent post-decompression sinusitis.

並列關鍵字

Graves' ophthalmopathy ； orbital decompression ； paranasal sinusitis ； maxillary sinus ostium