外伤性视神经病变鼻内镜下视神经减压术的效果

The efficacy of endoscopic optic nerve decompression for the treatment of traumatic optic neuropathy

目的分析外伤性视神经病变鼻内镜下视神经减压术治疗的效果。方法搜集100例（100眼）外伤性视神经病变的临床资料。患者曾随机分为两组，每组各50例（50眼）。对照组采取药物治疗，观察组在药物治疗的基础上，联合鼻内镜下视神经减压术治疗。比较两组患者的治疗效果。结果观察组与对照组的治疗有效率分别为76．0％和36．0％，两组间的比较差异有统计学意义（P=0．000）；观察组22例无光感者有16例视力得到提高；13例光感者中有9例视力得到提高；11例眼前手动者中有9例视力得到提高，4例数指者视力全部得到提高；对照组20例无光感者有6例视力得到提高；14例光感者中有6例视力得到提高；12例眼前手动者中有5例视力得到提高；4例数指者中有1例视力得到提高。观察组OCT检查结果显著优于对照组（P=0．000）；观察组不良反应发生率显著低于对照组（P=0．000）。结论鼻内镜下视神经减压术对外伤性视神经病变有较好的治疗效果，能够有效改善视力。

Objective To analyze the efficacy of endoscopic optic nerve decompression for the treatment of traumatic optic neuropathy. Methods The data of 100 eyes of 100 patients with traumatic optic neuropathy from Jan. 2014 to Jun. 2016 were collected and they were randomly divided into observation group and control group, each group included 50 eyes of 50 cases. The control group were treated with medication, and the observation group were treated with optic nerve decompression under nasal endoscope combined with medication. The clinical efficacy in the two groups were compared. Results The effective rates of the observation group and the control group were 76.0% and 36.0%, the difference between the two groups was statistically significant （ P = 0. 000）. In observation group, there were 22 cases with no light perception. Among them the visual acuity improved in 16 cases. Among 13 cases of light perception, the visual acuity improved in 9 eases. Among 11 cases of HM, the visual acuity improved in 9 cases. Four cases of finger counting, the visual acuity all improved. In the control group, the visual acuity was improved in 6 cases among 20 cases with no light perception, in 6 cases of 14 cases of light perception, in 5 cases of 12 cases of HM, and in 1 case among 4 cases of finger counting. The result of OCT in the observation group was better than that of control group（ P = 0.000 ）. The incidence of adverse reactions in the observation group was lower than that in the control group （ P = 0.000）. Conclusion Optic nerve decompression is effective and safe in the treatment of traumatic optic neuropathy. The visual acuity can be improved.