摘要
目的:分析经鼻视神经减压治疗外伤性视神经病(TON)的远期疗效,探讨影响手术远期疗效的可能因素。方法:39例TON患者术前均行视神经管CT扫描、闪光视觉诱发电位及视力视野检查。经鼻视神经减压术均在全身麻醉下进行,内镜下自眶尖至视神经管颅口将视神经管内侧壁及部分上下壁(视神经管周径的1/2以上)进行减压,根据术前CT及术中情况决定是否行视神经鞘膜切开;术后随访包括定期视力视野检查、眼底检查、鼻内镜鼻腔处理。结果:39例(39眼)患者的有效率为30.77%(12/39),无效率为69.23%(27/39);术前视力为光感及以上者有效率为85.71%,无光感者为18.75%,两者差异有统计学意义(P<0.05);外伤到手术时间<7d者有效率为34.38%,≥7d者为14.29%,差异无统计学意义(P>0.05);术中行鞘膜切开者有效率为26.32%,未切开者为35.00%,差异无统计学意义(P>0.05)。术后6个月视力趋于稳定,无手术并发症发生。结论:经鼻内镜视神经减压治疗TON的远期疗效稳定;术前有残余视力者疗效优于无光感者;外伤至手术时间长短及视神经鞘膜切开与否不是远期疗效的决定因素;避免外伤后视神经的继发损害是提高TON远期疗效的关键。
Objective：To analyze the long-term efficacy of nasal endoscopic opticnerve decompression for traumatic optic neuropathy（TON）and to explore its possible influencing factors.Method：To summarize the clinical data of 39 cases underwent transnasal decompression,which were followed-up for more than 1year.The data,including optic canal CT scanning,flashed-elicited visual-evoked potential（FVEP）,preoperational vision and visual field examination were reviewed.Nasal endoscopic optic nerve decompression was preformed.Whether or not optic nerve sheath incision decided to perform was according to preoperative CT and situations in operation.Postoperative follow-up including vision,visual field,funduscopy,nasal endoscopy were performed.Result：Total efficacy rate was 30.77%（12/39）,inefficacy rate was69.23%（27/39）.The efficacy rate was 85.71% with better than nolight perception,and the efficacy rate was 18.75%with nolight perception,the clinical effect in the group of preoperative better than nolight perception was better than that of nolight perception,the difference was statistically significant（P〈0.05）.The efficacy rate was 34.38% with duration of less than 7days from the traumatic point to the operation point,and the efficacy rate was 14.29% for more than 7days,but the difference was not statistically significant（P〉0.05）.The efficacy rate was 26.32% with optic nerve sheathincision,while the efficacy rate was 35.00% without optic nerve sheath incision,and there was no statistically significant difference（P〉0.05）;Postoperative vision tended to stabilize until about 6months post-operation,without complications.Conclusion：The long-term efficacy of nasal endoscopic opticnerve decompression for TON was certain;The efficacy with preoperative residual vision was better than that of nolight perception,the factor of long or short duration from the trauma point to the operation point and the factor of optic nerve sheath incision didn′t influence long curative effect.To avoid the secondary dama
出处
《临床耳鼻咽喉头颈外科杂志》
CAS
北大核心
2015年第12期1082-1085,共4页
Journal of Clinical Otorhinolaryngology Head And Neck Surgery
基金
国家临床重点专科建设项目基金资助
关键词
视神经损伤
减压术
外科
内镜检查
盲
optic nerve injuries
decompression,surgical
Endoscopy
Blindness
