内镜下平衡眶减压术治疗重度Graves’眼病

Endoscopic transnasal orbital balanced decompression technique for severe Graves＇ orbitopathy

目的探讨重度Graves’眼病的内镜下平衡眶减压手术方法及其疗效。方法对2010年7月至2014年6月天津市第一中心医院收治的6例12眼明确诊断为重度Graves’眼病并严重影响视觉功能及容貌的患者行平衡眶减压手术，即内镜下眼眶内、下壁减压术＋眼外侧开眶减压术。观察手术前后患者的视力、眼球突出度、眶内容积、平均睑裂高度、眶内压等指标。应用SPSS16．0软件对数据进行统计学分析。结果术后随访12—28个月，患者的视力、眼球突出度、眶内容积、平均睑裂高度分别从术前的（0．23±0．08）、（22．08±1．08）mm、（26．84±0．62）cm3、（12．03±0．91）mm，改善为术后1年的（0．48±0．13）、（15．67±1．44）mm、（31．56±1．10）m3、（8．62±0．75）mm，差异有统计学意义（t值分别为-5．749、17．924、-16．567、9．600，P值均〈0．001），术后眶内压较术前降低，差异有统计学意义（t值分别为-6．759、-一11．850、-6．189，P值均〈0．001）。术后3例患者出现复视，均于术后3—5个月后消失。结论鼻内镜下平衡眶减压术可能是治疗重度Graves’眼病的有效方法之一。

Objective To determine the efficacy of endoscopic transnasal orbital balanced decompression technique for the treatment of severe Graves＇ orbitopathy. Methods Six cases （ 12 eyes） of severe Graves＇orbitopathy were included in this study. All patients were undergone endoscopic transnasal orbital balanced decompression technique （ orbital inner and lower wall decompression ± lateral orbital decompression） for severe Graves＇orbitopathy and serious affecting visual function or appearance. Results The follow-up ranged from 12 months to 2 years and 4 months. Postoperatively, the visual acuity markly improved from 0. 23 ±0. 08 to 0.48 ±0. 13 （t = -5. 749, P 〈0. 001）. Proptosis measured by exophthalmoter distietly reduced from （22.08 ± 1.08 ） mm to （ 15.67 ± 1.44 ） mm （ t = 17. 924, P 〈 0. 001 ）. The palpebral fissures obviously reduced from （ 12.03 ± 0.91 ） mm to （ 8.62 ± 0.75 ） mm （ t = 9. 600, P 〈 0.001 ）, and orbital volume evidently increased from （26.84 ± 0.62） cm3 to （31.56 ± 1.10） cm3 （ t = - 16. 567, P 〈 0. 001 ）. Compared with the preoperative result, the orbital pressure was significantly decreased after operation （t = -6. 759 （Y = 100 g）, t = - 11. 850 （Y = 200 g）, t = - 6. 189 （ Y =300 g）, P 〈0.001 ）. Diplopia was appeared in 3 cases, and disappeared 3 to 5 months after surgery. Conclusion Endoscopic transnasal orbital balanced decompression technique is effective for the treatment of severe Graves＇orbitopathy.