神经内镜下视神经损伤经筛蝶窦入路减压术的临床观察

Clinical effect observation of transsphenoidal approach for decompression by nerve endoscopic in optic nerve injury

目的观察神经内镜下经蝶筛窦径路进行视神经减压术治疗外伤性视神经损伤的临床疗效。方法选取2002年1月-2007年12月医院神经外科收治的外伤性视神经损伤患者27例为保守组,行256极速CT眼眶薄层扫描,保守治疗患者予以激素冲击、营养神经及扩张血管等综合药物治疗;选取2008年1月-2013年12月手术治疗的外伤性视神经损伤患者14例,手术患者除保守治疗措施外,行神经内镜下经蝶筛窦视神经管减压术。随访6个月。依据治疗前后视力评分情况,比较2种治疗方案的视力恢复的疗效差异。结果全组病例均随访6个月,手术组视力改善有效率高于保守组(χ2=4.41,P<0.05)。2组治疗后的视力评分均高于治疗前,且手术组高于保守组(P<0.05)。结论神经内镜下经蝶筛窦径路进行视神经减压术治疗外伤性视神经损伤可提高治疗效果。

Objective To observe the clinical effect of transsphenoidal approach for decompression by nerve endoscopic in optic nerve injury. Methods Selected 27 cases patients with traumatic optic nerve injury from January 2002- December 2007 in the hospital of neurosurgery as conservative group,which was treated by comprehensive drug treatment,contains hormone shock,nutritional nerve,expansion of blood vessels. Selected 14 cases traumatic optic nerve injury from January2008- December 2013 in the hospital of neurosurgery as surgery group,which was treated by transsphenoidal decompression of ethmoid sinus optic canal under the neuroendoscopy,on the basis of conservative treatment. All patients were followed up for 6months. According to the visual acuity score before and after treatment,compared the vision recovery effect of 2 groups.Results All patients were followed up for 6 months,The effective rate of visual acuity improvement in surgery group,which was higher than that in conservative group(χ2= 4. 41,P < 0. 05). The visual acuity scores of 2 groups after treatment were higher than those before treatment,and the visual acuity score of surgery group was higher than that in conservative group(P <0. 05). Conclusion Transsphenoidal approach for decompression by nerve endoscopic in treatment of optic nerve injury can improve the therapeutic effect.