经鼻内镜视神经减压术治疗外伤性视神经损伤15例临床分析

Endoscopic optic nerve decompression in traumatic optic nerve injury:analysis of 15 cases

目的：观察经鼻内镜视神经减压术治疗外伤性视神经损伤的临床效果。方法：对15例（16眼）外伤性视神经损伤的患者经鼻内镜视神经减压术。结果：随访3-6个月,16眼中12眼视力有不同程度的提高,总有效率为74.9%。有光感以上的10眼中9眼视力有提高;无光感的6眼中3眼视力有提高（P=0.118）。伤后3-7天手术12眼,术后视力有改善的10眼;伤后〉7-16天手术4眼,术后视力改善的1眼,两者差异无统计学意义（P=0.063）。结论：经鼻内镜视神经减压术具有视野清晰,无需开颅,侵袭性小,头面部不遗留瘢痕,并发症少等优点。手术前无光感或伤后较长时间者,也不应该放弃手术治疗。

Objective：To analysis the clinical effect of optic nerve decompression surgery by endoscopic technique in traumatic optic nerve injury.Methods：Sixteen eyes from 15 cases（16 eyes） with traumatic optic nerve injury were treated with optic nerve decompression by endoscopic technique.Results：All patients were followed up for 3 to 6 months,the visual acuity was improved in twelve of 16 eyes,the total effective rate was 74.9%.Visual acuity in nine of 10 eyes with light perception or light grades and in three of 6 eyes with no light perception was improved（P=0.118）.It was improved in ten of 12 eyes who underwent operation within 3-7 days,and in one of 4 eyes who underwent operation more than 7-16 days（P=0.063）.Conclusions：The endoscopic technique offers several advantages over other surgical approaches.It provides excellent visualization of the surgical site,avoids the morbidity associated with intracranial and extracranial approaches,has low invasion and few syndrome,offers the best option for recovery of useful vision and no scar left in craniofacial regions.It should not be given up for these cases even who has no light perception or injured in longer time before the operation.