眼眶x线非造影剂异物的诊断困难及综合治疗的必要性

A. Kolesnikov, D. S. Pshennikov, I. Kirsanova, D. D. Kochetygova
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Left eye visual acuity = 1/∞PrLinc, IOP = T−3 (palpatory).Results. Control X-ray computed tomography (CT) of the orbits and paranasal sinuses (PNS) suspected the presence of a radiopaque foreign body. A rhinoendoscopic examination was performed by an otorhinolaryngologist and a fragment of a large wooden foreign body was found in the nasopharyngeal arch. Surgeons of the ophthalmologic and otorhinolaryngologic departments performed surgery: removal of the foreign body, endonasal endoscopic opening of the labyrinth on the left, endoscopic endonasal maxillary sinus maxillary sinus maxillotomy on the left, left microcoidectomy, resection of trauma-exposed tissue. During his stay in the 2nd Ophthalmologic Department of the Regional Clinical Hospital named after N.A. Semashko. N.A. Semashko Regional Clinical Hospital, the patient’s condition improved, infection was eliminated, prevention of possible complications was carried out. 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摘要

介绍。眼眶异物,尤其是器质性异物,在初次检查时往往难以诊断。详细的病史记录、临床检查和使用额外的成像技术是非常重要的。由于存在脓性炎症并发症的风险,异物必须通过手术切除。本文以临床观察为例,阐述了眼眶x线非造影剂异物的及时诊断和复杂治疗方法的重要性。材料和方法。病人r在跌倒后,左脸撞在金属角上,他抱怨左眼发红、疼痛、流泪和失明。左眼视力= 1/∞,眼内压= T−3(触诊)。对照x线计算机断层扫描(CT)眼眶和鼻窦(PNS)怀疑存在不透射线的异物。由耳鼻喉科医生进行鼻内窥镜检查,在鼻咽弓内发现一大块木制异物碎片。眼科、耳鼻喉科医师进行手术:异物取出术、鼻内窥镜下左侧迷宫开口术、鼻内窥镜下左侧上颌窦切开术、左侧微窦切除术、创伤暴露组织切除术。他在以na Semashko命名的地区临床医院第二眼科住院期间。na Semashko地区临床医院,患者病情好转,感染消除,预防可能的并发症。患者转至Pirogov国家医学外科中心,在那里进行了以下手术:微创玻璃体切除术+ FEC + PFOS +视网膜切除术+左眼硅油1300内膜填塞,并建议咨询激光外科医生进行激光虹膜切除术。本病例考虑采用综合方法治疗眶内异物,多学科专家团队的参与,而患者的康复之路仍很长。结论眼眶外伤伴异物入眶,准确的病史、及时的诊断、合理的手术及保守治疗至关重要。这将有助于避免严重的并发症,并防止视觉器官的视觉和动眼病。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Difficulties of diagnosis and the need for a comprehensive approach to treatment of patients with X-ray non-contrast orbital foreign bodies
Introduction. An orbital foreign body, especially of an organic nature, is often difficult to diagnose during the initial examination. A thorough history taking, clinical examination, and the use of additional imaging techniques are of great importance. Due to the risk of purulent-inflammatory complications, foreign bodies must be surgically removed.The aim of the work was to demonstrate the importance of timely diagnosis and complex approach to treatment of patients with X-ray non-contrast foreign bodies of the orbit using the example of clinical observation.Materials and methods. Patient R. came in with complaints of redness, pain, lacrimation and lack of vision in the left eye after falling and hitting the left side of his face on a metal corner. Left eye visual acuity = 1/∞PrLinc, IOP = T−3 (palpatory).Results. Control X-ray computed tomography (CT) of the orbits and paranasal sinuses (PNS) suspected the presence of a radiopaque foreign body. A rhinoendoscopic examination was performed by an otorhinolaryngologist and a fragment of a large wooden foreign body was found in the nasopharyngeal arch. Surgeons of the ophthalmologic and otorhinolaryngologic departments performed surgery: removal of the foreign body, endonasal endoscopic opening of the labyrinth on the left, endoscopic endonasal maxillary sinus maxillary sinus maxillotomy on the left, left microcoidectomy, resection of trauma-exposed tissue. During his stay in the 2nd Ophthalmologic Department of the Regional Clinical Hospital named after N.A. Semashko. N.A. Semashko Regional Clinical Hospital, the patient’s condition improved, infection was eliminated, prevention of possible complications was carried out. The patient was referred to the Pirogov National Medical-Surgical Center, where the following surgery was performed: microinvasive vitrectomy + FEC + PFOS + retinotomy + endotamponade with silicone oil 1300 of the left eye, and a consultation with a laser surgeon was recommended for laser iridectomy.Discussion The clinical case considers a comprehensive approach to the treatment of intraorbital foreign bodies, the participation of a multidisciplinary team of specialists, while the patient still has a long road to rehabilitation.Conclusion In orbital trauma with penetration of a foreign body, an accurate history, timely diagnosis, and rational surgical and conservative treatment are important. This will help to avoid serious complications and prevent visual and oculomotor disorders of the visual organ.
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