伴视力减退的鼻窦黏液囊肿的临床诊断和治疗  

Clinical diagnosis and treatment of nasal sinus mucoceles with visual loss

作　　者：胡鹏[1] 朱纲华[1] 赖若沙[1] 朱发梅[1] 肖自安[1] 杨新明[1] 李友忠[1] 

机构地区：[1]中南大学湘雅二医院耳鼻咽喉科,长沙410011

出　　处：《临床耳鼻咽喉头颈外科杂志》2011年第5期217-219,共3页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:总结引起视力减退的鼻窦囊肿的临床表现和治疗要点。方法:回顾性研究2002-2010年间收治的伴有视力下降的鼻窦囊肿患者23例,其中累及额窦或额筛窦10例,单纯累及筛窦6例,累及蝶窦或蝶筛窦7例。患者常以眼部症状为主,因此大多数首诊于眼科。因蝶窦与视神经紧密相邻,蝶窦和蝶筛窦囊肿引起严重视力障碍较其他窦腔囊肿更严重。CT和MRI是确诊鼻窦黏液囊肿的重要手段。对患者实施鼻内镜手术,开放鼻窦开口,清除窦腔内囊肿及行视神经减压。术后均使用激素治疗并常规行鼻内镜复查。结果:术后所有患者眼部突出、复视、眼球运动障碍等症状好转,但视力恢复程度不一,与手术时机和视力下降严重程度有关。未及时手术者视力恢复效果较差,而视力完全丧失无光感者,即使行视神经管减压术,预后仍明显低于有残余视力者。结论:鼻内镜手术是治疗伴视力减退的鼻窦囊肿的有效手段,提高对该病的警惕和早期影像学检查对于其诊断非常重要,早期诊断和及时手术治疗是恢复患者视力的关键。Objective：To review the clinical manifestations and management of nasal sinus mucoceles with visual loss.Method：Medical records for 23 patients of paranasal sinus mucoceles with visual impairment were reviewed retrospectively during 8-year period（from 2002 to 2010）.Ten mucoceles were found in the frontal or fronto-ethmoidal sinuses,6 in the ethmoidal sinuses,7 in the sphenoidal or spheno-ethmoidal sinuses.Because the majority of early chief complaints were problems related to vision,patients were often seen by ophthalmologists first.Poor vision was more common in patients with sphenoid or spheno-ethmoidal sinus mucoceles because of their proximity to the optic nerve.CT and MRI were important tools for diagnosing nasal sinus mucocele.The patients received endoscopic surgery to remove mucocele and to decompress the optic nerve.Steroid therapy was given postoperatively and routine examination with endoscopy were carried out during follow-up.Result：Postoperatively,the majority of symptoms,such as exophthalmos,epiphora,diplopia and headache,disappeared in all patients.However,vision recovery was observed only in some patients.Recovery of vision depended on the timing of surgery and severity of initial visual loss.Delay in treatment can seriously compromise recovery of vision impairment.Moreover,patients without light perception before surgery had poor visual recovery even if optic nerve decompressions were performed.Conclusion：Endoscopic surgery is effective to nasal sinus mucocele with visual loss.Because visual recovery depends on prompt diagnosis and surgical intervention,a good understanding of the disease and prompt imaging studies are important.

关 键 词：鼻窦囊肿 视力减退 鼻内镜手术 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]