鼻内镜下筛蝶径路视神经减压术治疗外伤性视神经损伤

Clinical study of decompression of optic nerve through combined ethmoid and sphenoid approach

目的探讨鼻内镜下筛蝶径路视神经减压术对于外伤性视神经损伤的临床疗效。方法收集2008年10月至2012年9月间47例外伤性视神经损伤病例,其中15例行视神经减压,32例行内科保守治疗。根据治疗前视力,将患者分为失明、仅存光感和残存视力3类,随访6个月,比较各类患者中2种治疗方案有效率的差异。结果 19例失明患者中,视神经减压与内科保守治疗的有效率差异无统计学意义(P>0.05);23例仅存光感患者中,视神经减压治疗有效率显著较内科保守治疗增加(P<0.05);5例残存视力患者均采用内科保守治疗,4例有效,1例随访未有恶化。结论外伤性视神经损害病例应适当注重个体化治疗,根据病情和视力评估行视神经减压手术,视神经减压术相对较为安全,特别是对仅存光感的患者有助于视力恢复。

Objective To explore the clinical effectiveness of transnasal endoscopic optic decompression for traumatic optic injuries. Methods Forty-seven patients with traumatic optic injuries were enrolled at our department from October 2008 to September 2012. Fifteen cases were treated with optic nerve decompression via combined ethmoid and sphenoid approach under nasal endoscope, and the others were treated with medication. According to the vision before treatment, the patients were divided into three groups： blindness, sense of light and resid- ual vision. After 6-month follow-up, the visual improvement rate was compared between different treatment in various groups. Results Among 19 patients of blindness, there was no significant difference between different treatment in the visual improvement rate. Among 23 patients hav- ing only sense of light, the visual improvement rate with optic nerve decompression was higher than that iu the patients with medication. Five cases of patients with residual vision all received medication, after treatment, 4 patients had obvious improvement in visual acuity, while 1 case did not deteriorate after 6-month follow-up. Conclusion Patients with traumatic nerve damage should be treated appropriately by individual therapy. The optic nerve decompression is surely effective and safe treatment for patients with traumatic optic injuries especially for sense of light.