双侧外伤性视神经损伤的经鼻内镜拯救手术

Surgical treatment for bilateral traumatic optic neuropathy through intranasal endoscopic approach

目的探讨双侧视神经损伤经鼻内镜手术治疗的必要性。方法对4例双侧外伤性视神经损伤导致完全失明的患者采用经鼻内镜视神经减压手术和综合性药物治疗,并分析其疗效。结果除1例伤后立即失明的患者外,其余伤后逐渐失明患者的视力治疗后均有不同程度的恢复。病例1伤后30d手术,单侧视力从光感恢复至1·5;病例2伤后3d手术,单侧视力从光感恢复至0·2;病例3伤后立即失明,双侧无光感,伤后6d手术,双侧视力均无恢复;病例4伤后28d手术,术前均无光感,术后左侧视力恢复至0·8,右侧恢复至0·2。结论对双侧外伤性视神经损伤导致失明的患者应积极采用手术治疗;长时间失明者仍有恢复视力的可能性;伤后视力逐渐丧失或遗留残余视力是手术治疗有效的基本依据,伤后即刻失明者,视力恢复的可能性较小。

Objective This study was aimed to explore the necessity of nasal endoscopic operation for bilateral traumatic optic neuropathy. Methods Four patients with complete blind resulted from traumatic impairment of bilateral optic nerves were selected to receive a combined treatment of nasal endoscopic optic nerve decompression （NEOND） with all-around medication. Results The vision of all patients was improved except one who lost vision immediately after trauma. Thirty days after injury, patient 1 was treated with NEOND, and the vision of left eye was restored to 1.5, however, the vision of right side was just from light perception （LP） to hand motion （HM）. Patient 2 was treated with NEOND 3 days after injury, and the vision was improved from LP to 0. 2 in left side, no change in right eye. The operation of patient 3 was performed 6 days after injury, but no improvement was observed in both visions. Patient 4 received NEOND 28 days after injury, the vision was improved in both sides with left eye from NLP to 0. 8 and right eye from NLP to 0. 2. Conclusions NEOND can be regarded as an effective treatment for bilateral traumatic blindness, even delayed NEOND may be effective. Both gradual vision loss and residual vision should be the indications for an effective NEOND, but immediate blindness after injury might be the index for poor result of NEOND.