内镜经鼻手术对视觉受损的颅底肿瘤患者视功能的影响及影响因素分析  

The impact of resection of skull base tumor via an endoscopic endonasal approach on the visual function of vision impaired patients and the analysis of factors affecting their visual recovery

作　　者：王振霖[1,3] 张秋航[1,2,3] 李茗初[2,3] 严波[1,3] 魏婷婷 彭舒娅 李谱[1,3] 曹连杰[1,3] Wang Zhenlin, Zhang Qiuhang, Li Mingchu, Yan Bo, Wei Tingting, Peng Shuya, Li Pu, Cao Lianjie Department of Otorhinolaryngology Head and Neck Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China(Wang ZL, Zhang QH, Yah B, Wei TT, Peng SY, Li P, Cao L J） ; Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Belting 100053, China （ Zhang QH, Li MC） ; Skull Base Surgery Center, Xuanwu Hospital, Capital Medical University, Beijing 100053, China （ Wang ZL, Zhang QH, Li MC, Yah B, Wei TT, Peng SY, Li P, Cao LJ)

机构地区：[1]首都医科大学宣武医院耳鼻咽喉头颈外科,北京100053 [2]首都医科大学宣武医院神经外科,北京100053 [3]首都医科大学宣武医院颅底外科中心,北京100053

出　　处：《中华耳鼻咽喉头颈外科杂志》2018年第4期244-250,共7页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：北京市卫生系统高层次人才培养计划项目（20133093）;北京市属高等学校青年拔尖人才培育计划（CIT＆TCD201504095）

摘　　要：目的评价术前存在视功能障碍的颅底肿瘤患者在内镜经鼻手术后的视功能结果，并分析其影响因素。方法回顾性分析2014年1月至2016年12月间，153例就诊于首都医科大学宣武医院颅底外科中心术前有视功能障碍的颅底肿瘤患者，收集采用内镜经鼻入路手术之后的治疗结果。使用卡方检验和Logistic回归分析对术前和术后的视功能状况及可能影响视功能康复结果的影响因素进行分析。结果本组病例的肿瘤全切率为85．6％。女性患者的术后视功能康复有效率（86．1％）高于男性（73．9％）；良性肿瘤者（90．2％）高于恶性肿瘤者（20．0％）；无视神经萎缩组（97．1％）高于有视神经萎缩组（51．2％）；急性患者（96．6％）高于慢性患者（80．0％）。以上因素各组间的视功能康复有效率比较，差异有统计学意义（χ2值分别为5．849、87．860、79．757、4．745，P值均〈0．05）。其中，肿瘤的性质和视神经萎缩与否对术后视功能康复的影响具有统计学意义（Wald χ2值分别为18．597和35．623，P值均〈0．001）。结论内镜经鼻入路颅底肿瘤切除术在切除肿瘤的同时可改善多数患者的视功能，在患者尚未出现视神经萎缩之前的早期阶段开展治疗，可能对保存和改善其视功能有较大裨益。Objective To evaluate the visual outcomes of patients with visual impairment after resecting skull base tumor via an endoscopic endonasal approach, and to analyze the factors affecting visual recovery. Methods One hundred and fifty-three patients with skull base tumor who suffered from preoperative visual impairment from Skull Base Surgery Center of Xuanwu Hospital were operated through an endoscopic endonasal approach. Both preoperative and postoperative visual function outcomes as well as factors that might have affected their visual recovery were analyzed retrospectively by Chi square test and Logistic regression analysis. Results Complete resection was achieved in 85.6% of the patients using this technique. The rate of postoperative visual recovery in the female group （86. 1% ） was higher than that in the male group （ 73.9% ）, the benign group （ 90. 2% ） higher than the malignant group （ 20. 0% ）, the group without optic atrophy （97.1%） higher than the one with （51.2%）, and the acute group （96.6%） higher than the chronic group （ 80. 0% ）. Significant differences were found between the abovementioned groups （χ2 value was 5. 849, 87. 860, 79. 757, 4. 745, respectively, all P 〈 0. 05 ）. The degree of optic atrophy and the property of tumors were significantly associated with visual improvement after treatment （ Wold χ2 value was 18. 597 and 35. 623, all P 〈 0. 001 ） . Conclusions Our results indicate that endoscopic endonasal surgery shows its ability both to resect skull base tumors and to improve visual function in the majority of patients. The timing of treatment for patients suffered from preoperative visual impairment should be selected in early stage before optic atrophy occurs.

关 键 词：颅底 视觉 双眼 内窥镜检查 耳鼻喉外科手术 肿瘤 

分 类 号：R739.4[医药卫生—肿瘤]