视神经外伤经筛、蝶窦径路减压术治疗(附35例报告)  

Trans-ethmoidal optic nerve decompression in traumatic optic neuropathy

作　　者：顾能荣[1] 殷善开[1] 沈平江[1] 柯国欣[1] 

机构地区：[1]上海市第六人民医院耳鼻咽喉科,200233

出　　处：《临床耳鼻咽喉科杂志》1998年第10期451-453,共3页Journal of Clinical Otorhinolaryngology

摘　　要：为了解经筛、蝶窦径路行视神经减压术对外伤性视神经损伤治疗的有效性及手术时机的选择作回顾性研究。对41例外伤性视神经损伤患者中的35例行经筛、蝶窦径路减压术，另6例应用大剂量皮质激素保守治疗。结果手术者中13例视力得到改善，保守治疗者中1例视力改善。12例治疗前有残余视力的患者，8例接受手术治疗，其中7例视力得以改善；4例接受保守治疗者，1例视力得以改善。29树治疗前无光感的患者，27例接受手术治疗，其中6例视力得以改善；2例接受保守治疗者，视力均未得到改善。结论：经筛、蝶窦径路视神经减压术可有效地改善外伤性视神经损伤的预后，如能尽早手术，手术前后应用大剂量皮质激素能够改善该病预后。伤后视力完全丧失及视觉诱发电位患侧无波并非手术绝对禁忌证。To evaluate the outcome of trans-ethmoidal optic nerve decompression (TOND).Method: Between November 1984 and May 1996, 35 patients with traumatic optic neuropathy (TON) underwent TOND. While 6 patients were treated with high dose corticosteroids (HDC). Result: 13(37. 14% ) cases of 35 patients who underwent TOND showed improvement in vision. 1 (16.67% ) of 6 patients who were treated with HDC showed improvement in vision. Of the 12 patients with some initial vision, 8 patients underwent TOND and 7 (87. 5%) patients showed improvement in vision. Another 4 patients treated with HDC, 1 (25.0% ) patient showed improvement in vision. Of the 29 patients who presented with no light perception, 27 patients underwent TOND and 6 (22. 22% ) patients showed improvement in vision. 2 patients treated with HDC failed to get vision improvement. Conclusion:TOND can improve vision in patients with TON. It is rational to perform surgical decompression early. Using of HDC before and after surgery may improve the outcome of TON. No light perception and absence of waveform on visual evoked response is not contradict,some patients may show inlprovement in vision.

关 键 词：减压手术 筛窦 蝶窦 视神经损伤 

分 类 号：R774.605[医药卫生—眼科] R779.105[医药卫生—临床医学]