经鼻内镜眶尖-视神经管减压术治疗外伤性视神经病变(附88例报告)  

Endoscopic apex-optic nerve canal decompression of traumatic optic neuropathy( 88 cases)

作　　者：赵尚峰[1] 刘浩成[1] 李永[1] 董浩[1] 孙思[1] 邱锷[1] 张家亮[1] 吴江平[1] 王卫[1] 傅继弟[1] 康军[1] 

机构地区：[1]首都医科大学附属北京同仁医院神经外科,北京100730

出　　处：《中华腔镜外科杂志（电子版）》2015年第3期6-9,共4页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

基　　金：973计划项目资助(2005CB724302);北京市科委首都临床特色应用研究项目(Z131107002213085)

摘　　要：目的观察经鼻内镜眶尖-视神经管减压术治疗外伤性视神经病变的手术效果,总结经验。方法回顾性分析2011年5月至2013年5月收治的外伤性视神经病变行经鼻内镜眶尖-视神经管减压术88例(90只眼)患者资料,其中男性85例,女性3例,平均年龄27.5岁;视力完全失明64只眼(手术前视力完全失明组),有残存视力26只眼(有残存视力组),从受伤到手术平均时间7.5 d,均采用经鼻内镜眶尖-视神经管减压术,观察和分析术后视力恢复及术后并发症情况。结果手术前视力完全失明组64只眼,其中视力改善25只眼(39.9%),达到有效视力16只眼(25.0%);有残存视力组26只眼,其中视力改善24只眼(92.3%),达到有效视力22只眼(84.6%)。残存视力组视力恢复明显高于视力完全失明组(P<0.01)。脑脊液漏3例(3.4%),颈内动脉假性动脉瘤2例(2.7%),对症治疗后痊愈出院。结论经鼻内镜眶尖-视神经管减压术是治疗外伤性视神经病变的安全、有效的治疗方法,能够促进视功能恢复。Objective To summarize the experience and prognosis of endoscopic apex-optic nerve canal decompression in traumatic optic neuropathy. Methods A total of 88 cases（ 90 eyes） of TON underwent endoscopic apex-optic nerve canal decompression from May 2011 to May 2013,including 85 cases of male and 3 cases of female,with median age of 27. 5 years. The pre-operative vision acuity is total blind in 64 eyes and remnant vision in 26 eyes. The median duration from trauma to operation is 7. 5 days. The visual recovery and post-operative complications were recorded and analyzed. Results 25 eyes（ 39. 9%）recovered from in blind group,of which 16 eyes achieved effective vision; 24 eyes（ 92. 3%） improved in remnant vision group and 22 cases（ 84. 6%） achieved effective vision; The visual recovery in remnant group is higher than that of blind group（ P 0. 01）. The complications include cerebral-spinal fluid leakage（ n =3,3. 4%） and pseudo-aneurysm of Internal carotid artery（ n = 2,2. 7%）. All the above cases were discharged after corresponding therapy. Conclusions We conclude that endoscopic apex-optic nerve canal decompression can effectively improve visual acuity in traumatic optic nerve neuropathy with minimal morbidity.

关 键 词：经鼻内镜眶尖-视神经管减压术 外伤性视神经病变 预后 并发症 

分 类 号：R651.15[医药卫生—外科学]