鼻腔鼻窦骨纤维良性肿瘤导致视神经病损的经鼻内镜挽救性手术  

Endoscopic salvage treatment for optic neuropathy caused by sinonasal fibro-osseous lesions

作　　者：邓洁[1] 陈枫虹[1] 赖银妍[1] 史剑波[1] 

机构地区：[1]中山大学附属第一医院耳鼻咽喉科医院,广州510080

出　　处：《中华耳鼻咽喉头颈外科杂志》2017年第9期654-658,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的 总结鼻腔鼻窦骨纤维良性肿瘤导致视神经病损的经鼻内镜手术疗效和技巧.方法 回顾性分析2007-2016年间于中山大学附属第一医院耳鼻咽喉科医院诊治的骨纤维良性肿瘤导致的视神经病损8例,所有患者均行经鼻内镜视神经减压术和/或肿瘤切除术,并随访至2017年4月.分析其不同的病理类型、病变范围与病程,比较手术前后患者视力及视野的改变.结果 8例患者中男性5例,女性3例,年龄8-19岁,中位年龄12岁,病程1~72个月,中位数病程12个月.5例患者视力提高,分别由术前的40 cm/指数、0.2、0.1、10 cm/指数、0.2提高到术后的0.1、0.3、1.2、0.1、0.6;1例患者视力无改变;2例患者视力下降,由术前的0.02、手动降到术后无光感.1例患者出现筛前动脉损伤导致的眶内出血.无出现脑脊液鼻漏、眼肌损伤、颅内出血和脑组织损伤等并发症的患者.结论 经鼻内镜视神经减压术和/或肿瘤切除术治疗鼻腔鼻窦骨纤维良性肿瘤导致的视力障碍,可以获得较好的临床效果.Objective To summarize the surgical techniques,benefits and limitations of transnasal endoscopic resection and optic nerve decompression for patients with optic neuropathy caused by fibro-osseous lesions.Methods Eight patients with optic neuropathy caused by fibro-osseous lesions who accepted endoscopic surgery of either resection of the lesion or decompression of optic nerve in Otorhinolaryngology Hospital,First Affiliated Hospital of Sun Yat-sen University from 2007 to 2016 were retrospectively reviewed and followed until April,2017.Analyses were performed on the pathology type,disease extent and disease duration,especially on the visual acuity and visual field changes before and after surgery.Results Eight patients （5 male and 3 female） were included in this study,with a median age of 12 years old （8-19 years old）.The median disease duration was 12 months （1-72 months）.The visual acuity （VA） of five patients （40 cm/FC,0.2,0.1,0.2,10 cm/FC,respectively） improved after surgery （0.1,0.3,1.2,0.1,0.6,respectively）,and one patient had no change of VA after the surgery.Two patients （0.02,hand movement,before surgery） became deprived of light perception （VA=0） immediately after surgery.One patient complicated with intra orbital hemorrhage because of anterior artery injury.No complications of cerebral spinal fluid leak,intra-ocular muscle injury,intra-cranial hemorrhage or brain tissue injury occurred.Conclusion For the treatment of optic neuropathy caused by fibro-osseous lesions,transnasal endoscopic surgery might have a good outcome.

关 键 词：鼻窦 骨瘤 纤维瘤 骨化性 纤维发育不良 骨 视神经损伤 内窥镜 耳鼻喉外科手术 

分 类 号：R739.62[医药卫生—肿瘤] R774.6[医药卫生—临床医学]