经鼻内镜微创手术治疗视功能障碍疾病的探讨

Transnasal endoscopic surgery for optic function damage relative to rhinology

目的探讨鼻科临床相关视功能障碍的病因、诊断、经鼻内镜手术治疗及效果。方法回顾性分析鼻源性球后视神经炎、外伤性视神经病、异物性视神经病及眶肿瘤引起的视功能障碍115例(117眼)的病因、诊断、经鼻内镜治疗经过及效果,术后随访6个月～4年。结果44例球后视神经炎有效率95.5%,外伤性视神经病64例有效率41.5%,异物性视神经病2例中1例视力改善,5例眶肿瘤视力和其他眼症状均获不同程度改善。结论与鼻科临床相关的视功能障碍最常见病因是头部钝性闭合性外伤,其次是鼻窦炎性疾病,鼻窦肿瘤、异物伤和恶性肿瘤转移引起者相对少见;经鼻内镜手术是主要有效的治疗方法。

[Objective] To explore the etiologies, diagnosis and the surgical treatment of optic function damage relative to rhinology through transnasal endoscopic approach. [Methods] The clinical characteristics and the results of transnasal endoscopic surgery of 115 cases （117 eyes） with optic function damage were retrospectively analyzed. The main etiologies included retrobulbar optic neuritis, traumatic optic neuropathy, optic neuropathy caused by foreign body, and orbital tumor. All these cases were followed up from 6 months to 4 years postoperatively. [Results] 95.5% were improved in 44 patients suffering from retrobulbar optic neuritis. 41.5% were improved in 64 patients suffering traumatic optic neuropathy. In 2 patients with optic neuropathy caused by foreign body, 1 patient was improved. In 5 cases of orbital tumor, visual acuity and other symptoms of eye were improved in different level. [Conclusion] The most frequent cause of optic function damage relative to rhinology is the blunt closed trauma on head, and the secondary is the sinus inflammatory diseases. Transnasal endoscopic surgery is an effective therapy.