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目的:提高鼻内镜手术的安全性和减少术后眼部并发症。方法:报告和分析3例慢性鼻窦炎和鼻息肉患者经鼻内镜手术及凡士林纱条填塞后并发的眼睑脂肪肉芽肿及其处理。结果:3例均因经鼻内镜手术时损伤同侧眶内壁纸板,术后2～3h出现眶周肿胀、眼睑淤血和睑结膜水肿,10～24h内抽出鼻腔凡士林纱条,6～8d眼部肿胀和眼睑淤血消退、鼻腔通气良好出院。术后12～15d出现同侧眼睑肿胀和眼脸皮下结节性肿块(左上睑1例,右下睑2例),眼球活动和视力正常。静脉用抗生素和糖皮质激素治疗3～4周仅能暂时减轻眼睑肿胀。术后1～6个月经睑缘切口,完全切除眼睑内肿块后痊愈,术后病理诊断为脂肪肉芽肿。随访4～18个月无任何眼部不适和复发。结论:鼻内镜手术损伤眶纸板和出血,以及凡士林纱条填塞致凡士林渗入眼睑内是产生眼睑脂肪肉芽肿的直接原因;确认有眶纸板损伤后不宜用凡士林纱条作为止血填塞;彻底清除眼睑内肉芽肿病灶是最有效的方法。
Objective: To improve the safety of endoscopic sinus surgery and reduce postoperative complications of the eye. Methods: Report and analysis of eyelid fat granuloma and its treatment in 3 patients with chronic sinusitis and nasal polyp after endoscopic sinus surgery and vaseline gauze. Results: All the 3 cases suffered damage to ipsilateral orbital wall paperboard during endoscopic sinus surgery. Periorbital swelling, eyelid congestion and palpebral conjunctival edema occurred 2 ~ 3h after operation. Vaseline gauze was removed within 10 ~ 24h and 6 ~ 8d Eye swelling and eyelid congestion subsided, nasal discharge well discharged. 12 ~ 15d postoperative ipsilateral eyelid swelling and ocular subcutaneous nodular mass (left upper eyelid in 1 case, right lower eyelid in 2 cases), eye movement and normal vision. Intravenous antibiotics and glucocorticoids for 3 to 4 weeks can only temporarily reduce eyelid swelling. Postoperative 1 to 6 months by eyelid incision, complete excision of the eyelid after the healed postoperative pathology diagnosis of fatty granuloma. Follow-up 4 to 18 months without any eye discomfort and recurrence. Conclusion: Nasal endoscopic surgery injury of the orbital cardboard and bleeding, as well as Vaseline gauze caused by petrolatum into the eyelid is the direct cause of eyelid fat granuloma; confirmed after orbital cardboard injury should not be used as a hemostatic gauze gauze packing; complete eradication of the eyelid Granulomatous lesions are the most effective method.