鼻内镜下视神经减压术治疗外伤性视神经病72例

Endoscopic optic nerve decompression in traumatic optic neuropathy:analysis of 72 cases

目的 探讨视神经减压术治疗外伤性视神经病的疗效。方法 对大剂量糖皮质激素冲击治疗无效的外伤性视神经病患者72例（73眼），采用鼻内镜下视神经减压术治疗。外伤至手术时间1～57d，其中≤3d15例，4—7d37例，8—10d9例，11—15d5例，16～30d5例，〉30d1例。术前视力：光感以上18眼；无光感55眼。结果 术后随访3个月-5年。73眼中46眼视力有不同程度的提高，总有效率63．01％。原无光感的55眼中，31眼视力有提高，有效率56．36％。有光感以上视力的18眼中，15眼视力有提高，有效率83．33％。术后全部患者术腔上皮化，术中无并发症发生。结论 经鼻内镜筛蝶窦入路视神经减压术进路简捷，损伤较小、疗效确切，且不遗留面部瘢痕，容易为患者所接受。对伤后时间较长、大剂量激素治疗无效、视力损伤严重的患者，手术仍有挽救视力的可能。

Objective To review the effects of optic nerve decompression by endoscopic technique in traumatic optic neuropathy. Methods Seventy-two patients （73 eyes） with traumatic optic neuropathy which were treated with large dose of glucocorticoid but inefficacious were undergone endoscopic optic nerve decompression. The days from injury to surgery were 1-57 d. Among that, ≤3 d 15 cases, 4-7 d 37 cases, 8-10 d 9 cases, 11-15 d 5 cases, 16-30 d 5 cases, 〉30 d 1 cases. The vision of pro-operation： with light perception or higher grades 18 eyes;with no light perception 55 eyes. Results All patients were followed up for more than 3 months. Fourty-six of 73 eyes had improvements in visual acuity, the total effective rate was 63.01%. Thrity-one of 55 eyes with no light perception had raises in visual acuity （ 56. 36% ）. Fifteen of 18 eyes with light perception or higher grades had improvements （83.33%）. No complication had happened. Conclusions Endoscopic optic nerve decompression is an appropriate technique for patients with traumatic optic neuropathy. Even though the patient has injured in longer time and high-dose steroid treatment has failed, optic nerve decompression may improve visual acuity.