经鼻内镜视神经管减压对儿童外伤性视神经病变的疗效及其影响因素  

Efficacy and prognostic factors of endoscopic optic canal decompression in children with traumatic optic neuropathy

作　　者：李永[1] 孙博文 孙思[1] 赵尚峰[1] 代从新 康军[1] Li Yong;Sun Bowen;Sun Si;Zhao Shangfeng;Dai Congxin;Kang Jun(Department of Neurosurgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

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：《中华医学杂志》2022年第47期3769-3773,共5页National Medical Journal of China

摘　　要：目的探讨经鼻内镜视神经管减压对儿童外伤性视神经病变的疗效及其影响因素。方法回顾性分析2010年11月至2021年10月北京同仁医院神经外科收治的行经鼻内镜视神经减压术的47例视神经损伤儿童患者临床资料,比较治疗前后视力情况。并将临床因素作为自变量,以治疗后视力有无好转为因变量纳入多因素Cox回归模型进行分析,观察可能影响疗效的因素。结果47例患者,男35例,女12例,年龄3.0~12.0(7.2±2.3)岁。经手术以及激素治疗后,28例(59.6%)患者视力较治疗前明显好转。伤后残存视力者术后视力好转率高于伤后无视力者[85.0%(17/20)比40.7%(11/27),P=0.002],视神经管移位骨折者术后视力好转率低于无移位骨折者[42.1%(8/19)比71.4%(20/28),P=0.044],手术时间间隔≤7 d者视力好转率高于>7 d者[80.8%(21/26)比33.3%(7/21),P=0.001]。伤后残存视力(HR=3.805,95%CI:1.087~13.318,P=0.037)和手术时间间隔≤7 d(HR=2.883,95%CI:1.084~7.662,P=0.034)是术后视力的保护因素。结论经鼻内镜视神经管减压术能够有效提高儿童外伤性视神经病变的视力,伤后残存视力和手术时间间隔≤7d是儿童外伤性视神经病变经鼻内镜视神经管减压术后视力预后的保护因素。Objective To explore the efficacy and prognostic factors of endoscopic optic canal decompression in children with traumatic optic neuropathy(TON).Methods The clinical data of 47 children with TON treated with endoscopic optic nerve decompression in the Department of Neurosurgery of Beijing Tongren Hospital from November 2010 to October 2021 were retrospectively analyzed,and the visual acuity before and after treatment was compared.The clinical factors were taken as independent variables,and visual improvement was taken as dependent variable for multivariate Cox regression analysis to observe the factors that may affect the efficacy.Results There were 47 patients in this study,including 35 males and 12 females,and the age ranged from 3.0 to 12.0(7.2±2.3)years.After surgery and hormone treatment,28(59.6%)cases obtained visual improvement.Univariate analysis showed that the improvement rate of visual acuity in patients with residual vision after injury was higher than that in patients without vision[85.0%(17/20)vs 40.7%(11/27),P=0.002],while the improvement rate of visual acuity in patients with dislocated optic canal fracture was lower than that in those without fracture[42.1%(8/19)vs 71.4%(20/28),P=0.044].The improvement rate of visual acuity in patients with operation time interval≤7 d was higher than that in patients with operation time interval>7 d[80.8%(21/26)vs 33.3%(7/21),P=0.001].Multivariate Cox regression analysis showed that post-traumatic residual visual acuity(HR=3.805,95%CI:1.087-13.318,P=0.037)and operation time interval≤7 d(HR=2.883,95%CI:1.084-7.662,P=0.034)were protective factors for post-surgical visual acuity.Conclusions Endoscopic optic nerve decompression can effectively improve the visual acuity of children with TON.Post-traumatic residual visual acuity and operation time interval≤7 d are independent protective factors for post-surgical visual acuity.

关 键 词：儿童 外伤性视神经病变 预后因素 随访研究 

分 类 号：R779.6[医药卫生—眼科]