外伤性视神经病变经视神经管减压术后临床疗效分析  

Analysis of clinical outcomes after transoptic canal decompression for traumatic optic neuropathy

作　　者：郭海星 陈奎 梁文佳 李海春 李艳新 朱青云 迁荣军 Guo Haixing;Chen Kui;Liang Wenjia;Li Haichun;Li Yanxin;Zhu Qingyun;Qian Rongjun(Department of Neurosurgery,Henan University People’s Hospital,Henan People’s Hospital,Henan Cerebrovascular Disease Hospital,Zhengzhou University People’s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南大学人民医院神经外科,河南省人民医院,河南省脑血管病医院,郑州大学人民医院,郑州450003

出　　处：《中华眼外伤职业眼病杂志》2022年第8期611-616,共6页Chinese Journal of Ocular Trauma and Occupational Eye Disease

基　　金：河南省重点科技攻关计划项目(202102310131)。

摘　　要：目的探讨外伤性视神经病变(TON)患者经视神经管减压术后治疗效果。方法回顾性病例对照研究。分析2018年12月至2021年11月河南省人民医院经视神经管减压术治疗TON 52例(52眼)的临床资料。按手术方式不同分为2组,32例经颅行视神经管减压术,20例经鼻内镜下行视神经管减压术。术后随访6个月,分析经视神经管减压术后患者视力恢复情况。结果术后6个月经鼻手术有效率为65.00%(13/20)略高于经颅手术的59.37%(19/32),差异无统计学意义(χ^(2)=0.69,P=0.165)。受伤与手术治疗时间间隔两组差异无统计学意义(P>0.05)。术前视力为光感及以上21例,视力改善17例,有效率为80.95%;术前无光感31例,视力改善15例,有效率为48.38%,差异有统计学意义(P=0.018)。结论视神经管减压术可有效改善TON患者视力,且两种减压手术术后6个月效果相似。术前无光感患者经手术治疗,视力恢复有效率低于术前有光感患者,应给予积极有效的治疗手段以提升术后生存质量。Objective To investigate the therapeutic effects of trans optic canal decompression in patients with traumatic optic neuropathy(TON).Methods This was a retrospective case control study.Fifty-two eyes of 52 cases with TON treated by trans optic canal decompression in Henan Provincial People’s Hospital from Dec.2018 to Nov.2021 were retrospectively reviewed.All cases were devided into two groups,based on different surgrical method.Thirty-two cases underwent optic nerve tube decompression transcranially,and 20 cases underwent endonasal optic nerve tube decompression.The visual acuity recovery after optic canal decompression was analyzed.Results At 6 months after operation,the 65.00%(13/20)of response rate by transnasal surgery was slightly higher than that of 59.37%(19/32)by transcranial surgery.The difference was not statistically significant(χ^(2)=0.69,P=0.165).There was no significant difference in the time interval between injury and surgical treatment(P>0.05).Preoperative visual acuity was light perception and above in 21 patients,visual acuity improved in 17 patients,and the response rate was 80.95%.The visual acuity was no light perception in 31 cases and improved in 15 cases,the effective rate was 48.38%(P=0.018).Conclusion Optic nerve tube decompression can improve vision for TON,and both decompressive procedures are with similar results at 6 months postoperatively.The effective rate of visual recovery by active surgical treatment in patients with no light perception preoperatively are lower than that in patients with light perception preoperatively.Active and effective treatments should be given to enhance the quality of survival after surgery.

关 键 词：视神经管减压术 河南省人民医院 无光感 病例对照研究 视力恢复情况 减压手术 术后生存质量 手术治疗时间 

分 类 号：R779.6[医药卫生—眼科]