眶悬带技术在内镜眶减压术中的应用  

Endonasal endoscopic orbital decompression:Primary experience of the orbital sling technique

作　　者：张维天[1] 程付伟[1] 张玉君[1] 朱华明[1] 郭金宝[1] 殷善开[1] 

机构地区：[1]上海交通大学附属第六人民医院耳鼻咽喉科,上海200233

出　　处：《山东大学耳鼻喉眼学报》2011年第6期52-55,共4页Journal of Otolaryngology and Ophthalmology of Shandong University

基　　金：上海市卫生局科研课题(2008163)

摘　　要：目的总结在经鼻内镜眶减压术中应用眶悬带技术,以降低术后复视发生率的初步经验。方法 6例共11眼行经鼻内镜眶壁减压术。其中包括5例(10眼)Graves眼病和1例(1眼)外伤后病例,手术采用眶悬带技术,即保留眼眶内壁赤道高度条带状眶骨膜以稳定内直肌及眼球,避免其过度疝入眶内而改变其运动矢量。对比术前、术后眼球突出度、复视、眼痛、结膜充血等变化。结果术后患者眼球突出度减少2～5 mm,平均回缩3.2 mm。术前2例存在复视,术后复视减轻,其余4例无术后复视发生。5例Graves眼病患者眼胀痛消失,结膜充血减轻,眼球活动度及外观改善。1例外伤病例双眼突出度接近,外观改善。结论在经鼻内镜眶减压术中保留位于内直肌内侧的条带样眶骨膜,使之成为稳定内直肌及眼球的悬带。该技术能够在保证眶脂肪自悬带上下方溢出而减压的同时,可有效预防术后复视的发生。Objective To evaluate the method and effect of the orbital sling technique in reducing the incidence of di- plopia following endoscopic orbital decompression. Methods Endoscopic orbital decompression was performed on 1 l orbits in 5 patients with proptosis from Graves disease and 1 patient from a traumatic case. The orbital sling technique, which tailors a horizontal strip of orbital periosteum, was used to prevent prolapse of the medial rectus muscle. Results No patients developed new-onset diplopia following the surgery. Of the 2 patients with pre-existing diplopia from the orbitopathy, double vision was improved in both patients and unchanged in the remaining four patients. The mean re- duction in proptosis was 3.2mm. Conclusions The preservation of a periosteum sling overlying the medial rectus mus- cle during endoscopic orbital decompression may reduce the incidence of post-operative diplopia, while still allowing for a satisfactory reduction in proptosis.

关 键 词：甲状腺相关眼病 鼻内镜外科手术 眶减压术 复视 突眼 

分 类 号：R777.4[医药卫生—眼科] R779.6[医药卫生—临床医学]