鼻内镜筛蝶窦入路视神经减压术37例分析

Transnasal Endoscopic Sphenoethmoidal Optic Nerve Decompression on 37 Eyes with Traumatic Optic Neuropathy

目的本课题通过开展鼻内镜下经鼻腔、筛蝶窦入路视神经减压术，探索治疗外伤性视神经病的最佳治疗方法与手术路径。方法外伤性视神经病37例37只眼，在外伤后1～30天内施行鼻内镜下经鼻腔、筛蝶窦入路视神经减压术。所有病人术前和术后给予激素治疗。根据最终视力分析影响疗效的因素。结果37例患者中21例术后视力获得改善，有效率为56．76％。PR—VEP监测中，能引出P100波的患眼术后疗效好于无P100波者（P=0．005）。结论（1）对于外伤性视神经病患者，大剂量激素冲击治疗无效时，应积极采用视神经减压术。（2）减压术后，视力恢复与否并不取决于伤后时间，而与视神经的损伤程度关系更大。对伤后1周以上者，手术减压仍有较好疗效。（3）术前视力有无光感，其手术后疗效有明显差别。但并非无光感患者就没有手术价值。（4）鼻内镜下视神经减压术，损伤小，疗效确切且不遗留面部瘢痕，有推广应用价值。（5）术前PR—VEP检测情况对预测预后有一定的帮助。PR—VEP检测应作为诊断外伤性视神经病的重要参考指标。

Objective The proper management of traumatic injuries to the optic nerve is controver sial. Recommendations for management of traumatic injuries to the optic nerve in the literature include expectant management,medical therapy, surgical treatment,and medical therapy combined with surgical decompression. Methods Thirty-seven patients（37 eyes）with traumatic optic neuropathy were enrolled. Transnasal endoscopic sphenoethmoidal optic nerve decompression was performed within 30 days after injury. Results The final visual acuity was improved in 21 patients （56. 76%）. The patients with presence of Pl00 wave in PR-VEP had better improvements than those without it （P=0. 005）. Conclusion The endo- scopic method offers many advantages over the traditional approaches. Decreased morbidity, preservation of olfaction,rapid recovery time,more acceptable cosmetic results with no external scars, no risk of injury to the developing teeth in children,and less operative stress in a patient who may have multisystem trauma are only some of the benefits associated with the endoscopic OND. The key factor in y was associated with the severity of optic nerve erauma. No light perception at factor in the outcome. There is no reason to give up treatment even if the time days. With or without Pl00 wave in PR-VEP is an important factor associated determining nerve recoverinitial is an important risk after injury is more than 7 with prognosis.