摘要
目的探讨鼻内镜下经蝶窦入路行视神经管减压术治疗创伤性视神经病变(traumatic optic neuropathy,TON)的疗效。方法回顾性分析陆军军医大学大坪医院2014年11月—2016年12月收治的19例TON患者的临床资料,均为男性,年龄10~63岁,平均30岁。术前视力:无光感7例,光感4例,手动5例,数指3例。所有患者术前甲强龙500mg冲击治疗视力无改善,采用鼻内镜经蝶窦入路的视神经管减压术,根据术前CT测量视神经管长度确定减压范围。随访6个月,观察患者视力恢复情况并分析治疗效果。结果 19例患者中术后视力提高11例,有效率57.9%;7例无光感患者中2例视力有提高,手术有效率28.6%;12例光感以上患者中有9例视力提高,有效率75%,其中最好视力达0.12。术后1例出现脑脊液漏,非手术治疗1周后痊愈;无鼻出血、副鼻窦炎发生。19例随访半年视力无明显改变。结论鼻内镜下经蝶窦入路视神经管减压术是一种安全有效的手术方式,具有创伤小、并发症少等优点,可成为TON手术治疗方式的选择之一。
Objective To observe the clinical effect of transsphenoidal approach for decompression by nerve endoscopy in traumatic optic neuropathy. Methods Clinical data of 19 patients diagnosed as having optic nerve injury in Department of Ophthamology,Daping Hospital from Nov. 2014 to Dec. 2016 were analyzed retrospectively. All of them were male,aged 10 ~ 63 years,with an average of 30 years. Preoperative vision was as follows： 7 cases of no light sensation,4 cases of light sensation,5 cases of manual sensation,and 3 cases of finger counting. All patients were treated with methylprednisolone for 500 mg and did not improve their eyesight with methylprednisolone treatment. All these patients were treated by transsphenoidal approach for decompression under nerve endoscopy. Decompression range was based on the length of optic canal measured by CT. The clinical therapeutic efficacy and the postoperative visual acuity of these patients were observed and analyzed for 6 months of follow-up.Results Clinical symptoms improved in 11 of the patients after surgery,with a total efficacy of 57. 9%. Of 7 patients who had no light perception,2 cases（ 2 eyes） got better after operation,and the rate of visual acuity improvement was 28. 6%. Nine patients（ 9 eyes） in the 12 patients with light perception before operation had improved vision after surgery,with the rate of visual acuity improvement of 75%. The best visual acuity was 0. 12. One patient had cerebrospinal fluid leakage after surgery and healed after conservative treatment. No nasal bleeding or paranasal sinusitis occurred. Nineteen patients had no significant changes in visual acuity after six months of follow-up. Conclusion Transsphenoidal approach for decompression by nerve endoscopy is effective in improving the visual acuity in optic nerve injury patients with minimal invasiveness and few complications,thus worth of option.
作者
周立萍
李佳
郝冰
袁洪峰
ZHOU Li-ping;LI Jia;HAO Bing;YUAN Hong-feng(Department of Ophthalmology,Daping Hospital,Army Medical University,Chongqing 400042,China)
出处
《创伤外科杂志》
2018年第6期422-426,共5页
Journal of Traumatic Surgery
基金
重庆市科委课题(cstc2015shmszx120107)
关键词
视神经损伤
鼻内镜
减压术
optic nerve injury
neuroendoscopy
decompression
