Medical management of orbital subperiosteal abscess in children.
Medical management of orbital subperiosteal abscess in children.
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儿童眼眶骨膜下脓肿的医疗治疗。
DOI：
10.3928/0191-3913-19890101-06
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发表时间：
1989
影响因子：
1.2
通讯作者：
C. Eng
中科院分区：
文献类型：
--
作者：
S. Rubin;Rubin Lg;J. Zito;Goldstein Mn;C. Eng
眼眶骨膜下脓肿的传统治疗方法包括手术引流和抗生素治疗。我们成功地用抗生素治疗了9名年龄26个月至12岁的儿童，他们有眼眶蜂窝织炎的临床症状和眼眶蜂窝织炎的临床症状，以及骨膜下脓肿和毗连性筛窦炎的CT证据。对另外两名成功接受非手术治疗的患者进行了回顾性研究。所有患者均在视力正常的情况下进入儿科。在疾病的早期阶段，每天对他们的视觉功能进行两次评估。所有患者经静脉注射抗生素治疗后均好转。在缓慢但稳定的临床改善一周后，另有一名患者因持续性疼痛而需要手术引流。其余患者均经单纯药物治疗临床治愈。其中五名内科“治愈”患者接受了治疗后的CT检查，记录了病情的解决情况。无一例复发。我们的结论是，眼眶骨膜下脓肿，就像其他地方的一些其他脓肿一样，可能适合非手术治疗，或者这些患者可能有粘液而不是脓肿，目前被接受的骨膜下脓肿的CT诊断标准可能需要修改。我们建议，没有证据表明视神经功能受损的邻接性筛窦炎骨膜下脓肿的儿童，在考虑手术引流之前，应尝试静脉注射抗生素治疗。
The traditional treatment of subperiosteal orbital abscess consists of surgical drainage and antibiotic therapy. We successfully treated with antibiotics alone nine children (age range 26 months to 12 years) with clinical signs and symptoms of orbital cellulitis and computerized tomographic (CT) evidence of subperiosteal abscess and contiguous ethmoid sinusitis. Two additional patients successfully treated with nonsurgical therapy were identified retrospectively. All patients were admitted to the pediatric service with normal vision. Their visual function was assessed twice daily during the early stages of their illness. All patients improved with intravenous antibiotic therapy. One additional patient required surgical drainage for persistent pain after 1 week of slow but steady clinical improvement. All other patients were clinically cured with medical therapy alone. Five of the medical "cures" had posttreatment CT, which documented the resolution. No patient had a recurrence. We conclude that orbital subperiosteal abscess, like some other abscesses located elsewhere, may be amenable to non-surgical treatment, or that these patients may have had a phlegmon rather than an abscess and the currently accepted CT criteria for diagnosis of a subperiosteal abscess may require modification. We recommend that children with a subperiosteal abscess from contiguous ethmoidal sinusitis who have no evidence of compromised optic nerve function be given a trial of intravenous antibiotic therapy prior to consideration of surgical drainage.