内镜下治疗鼻源性视觉障碍的临床研究

Clinical research on nasal endoscopic surgery for rhinogenous optic function damage

目的探讨鼻源性视觉障碍性疾病的诊断与治疗模式。方法回顾性分析23例（25眼）资料完整的鼻眼相关视功能障碍病例，23例均行内镜下鼻腔鼻窦探查＋鼻窦开放术，其中9例行视神经管减压术。结果双侧全组鼻窦炎4例，单侧后组筛窦、蝶窦炎6例，额窦、筛窦炎1例，孤立性蝶窦炎5例，单侧后组筛窦、蝶窦真菌病5例，单侧蝶窦、筛囊肿或脓囊肿2例，均经术后病理证实。术前视功能：2例（2眼）无光感；6例（7眼）眼前手动；7例（7眼）眼前指数（〈20cm）；8例（9眼）有不同程度视力下降。1例次（1眼）眼球突出、直接和间接瞳孔对光反射消失；3例次（3眼）复视；2例次（2眼）外展麻痹；3例次（3眼）视野缺损（1眼中央性，2眼颞侧）；1例次（1眼）上睑下垂。全部病例术后鼻窦术腔上皮化。术后视功能：2眼无改善；10眼恢复到发病前水平；13眼由术前眼前手动、指数改善到眼前指数（30～60cm）。其他眼部症状消失。结论鼻源性视觉障碍患者出现视力障碍时，若药物保守治疗无效应及早行鼻内镜下鼻腔鼻窦探查术；对严重视力障碍、视力急剧下降患者及早实施视神经减压手术，可以有效改善患者的视功能。

Objective To explore the surgical treatment of rhinogenous optic function damage （ROFD） through transnasal endoscopic approach. Methods Twenty-three patients （25 eyes） with ROFD were retrospectively reviewed. All patients were operated on through transnasal endoscopic approach, and 9 patients underwent endoscopic optic nerve decompression. Results Four patients had bilateral pansinusitis, 6 patients had unilateral posterior ethmoidal sinusitis and sphenoiditis. One patient had frontal and ethmoidal sinusitis. Five patients had fungal sinusitis occured in the sphenoid sinus and unilateral posterior ethmoid sinus. Two patients had unilateral pyocyst and cyst of the sphenoid and ethmoid sinus. The preoperative visual acuity preoperative were as follows ： 2 patients （ 2 eyes ） no light perception （ NLP）, 6 patients （ 7 eyes ） hand movement （HM） , 7 patients （7 eyes） fingers counting （FC） less than 20 cm and 8 patients （9 eyes） were vision impaired in different degree. One patient （1 eye ） was ophthalmoptosis, direct and indirect light reflex vanished. Three patients （3 eyes） diplopia, 2 patients （2 eyes） abduction parlysis, 3 patients （3 eyes） defect of visual field. One patient ptosis of upper lid. The visual acuity postoperative： 2 eyes failed, 10 eyes cured; 13 eyes improved from HM or FC to FC （30 -60 cm）. Conclusions The endoscopic sinus surgery combined with appropriate medical therapy are effective to ROFD. Patients who suffered from severe visual damage and either unresponsive or intolerant to medical treatment should be administrated endoscopic sinus surgery including endoscopic optic nerve decompression.