神经内镜经鼻筛蝶窦入路视柱磨除视神经管扩大减压术治疗外伤性视神经病变的临床疗效  

Clinical efficacy of optic nerve extended decompression through neuroendoscopic transethmoidal-sphenoidal approach in the treatment of traumatic optic neuropathy

作　　者：王洪财 谢作润 童贻蕾 汪浩[1] 李仕尉 陈茂送 王波定 Wang Hongcai;Xie Zuorun;Tong Yilei;Wang Hao;Li Shiwei;Chen Maosong;Wang Boding(Department of Neurosurgery,the Affiliated Li Hui Li Hospital of Ningbo University,Ningbo 315040,China;Department of Neurosurgery,Ningbo No.2 Hospital,Ningbo 315041,China)

机构地区：[1]宁波大学附属李惠利医院神经外科,宁波315040 [2]宁波市第二医院神经外科,宁波315041

出　　处：《中华神经外科杂志》2023年第11期1103-1109,共7页Chinese Journal of Neurosurgery

基　　金：宁波市医学重点学科建设项目(2022-F04);宁波市社会发展科技攻关项目(2021S172);宁波市自然科学基金(2019A610283)。

摘　　要：目的探讨神经内镜经鼻筛蝶窦入路视柱磨除视神经管扩大减压术治疗外伤性视神经病变(TON)的可行性和治疗效果.方法回顾性分析2018年3月至2022年10月宁波大学附属李惠利医院神经外科连续收治并行手术治疗的43例TON患者的临床资料.采用神经内镜经鼻筛蝶窦入路进行常规视神经管减压手术24例(对照组),应用神经内镜经鼻筛蝶窦入路视柱磨除视神经管扩大减压术式19例(试验组).比较两种不同术式的手术时长、术中出血量及住院时长等,术后观察患者的视力变化以评估手术的有效性,安全性评估指标为手术相关并发症的发生情况.结果对照组的手术时长为56.3~103.5 min[(76.6±23.4)min],试验组为75.1~121.6 min[(93.2±17.9)min],差异有统计学意义(t=2.55,P=0.009).两组间术中出血量及住院时长的差异均无统计学意义(均P>0.05).对照组的术前视力:无光感6例、光感10例、眼前手动6例、眼前指数2例;术后3个月,无光感5例、光感7例、眼前手动7例、眼前指数3例、LogMAR视力表≥0.022例,手术有效比例为9/24.试验组术前视力:无光感4例、光感7例、眼前手动6例、眼前指数2例;术后3个月,无光感3例、光感4例、眼前手动3例、眼前指数6例、LogMAR视力表≥0.023例,手术有效比例为13/19.两组间手术有效比例的差异有统计学意义(χ^(2)=4.06,P=0.036).两组无一例发生脑脊液鼻漏、颈内动脉损伤及嗅觉丧失等手术相关并发症.结论神经内镜经鼻筛蝶窦入路视柱磨除视神经管扩大减压术治疗TON在临床实践中安全、可行,并能提高对TON的临床疗效.Objective To explore the feasibility and efficacy of optic nerve extended decompression through neuroendoscopic transethmoidal-sphenoidal approach in the treatment of traumatic optic neuropathy(TON).Methods A retrospective analysis was performed on the clinical data of 43 patients of TON who were consecutively admitted and treated at the Department of Neurosurgery,the Affiliated Li Hui Li Hospital of Ningbo University from March 2018 to October 2022.The optic nerves of 24 patients(control group)were decompressed through neuroendoscopic transethmoidal-sphenoidal approach,whereas optic nerves of 19 patients(experimental group)were dealt with extended decompression through optic strut grinding.The duration of operation,intraoperative blood loss and hospitalization and so on were compared between the two groups.The efficacy of treatment was evaluated based on the visual change.Safety of treatment was determined based on the occurrence of postoperative complications.Results The duration of operation in control group ranged from 56.3 min to 103.5 min(mean:76.6±23.4 min),which was significantly different from that in experimental group(range:75.1-121.6 min,mean:93.2±17.9 min)(t=2.55,P=0.009).The intraoperative blood loss and hospitalization exhibited no statistical difference between the two groups(both P>0.05).Of 24 cases in the control group,there was no light perception in 6 cases,light perception in 10,hand motion in 6 and counting fingers in 2 before operation.At 3 months post operation,the results showed no light perception in 5,light perception in 7,hand motion in 7,counting fingers in 3 and Log MAR≥0.02 in 2.Of 19 cases in the experimental group,there was no light perception in 4 cases,light perception in 7,hand motion in 6 and counting fingers in 2 before operation.At 3 months post operation,the results showed no light perception in 3,light perception in 4,hand motion in 3,counting fingers in 6 and Log MAR≥0.02 in 3.The visual acuity of 9 patients in control group improved and that of 13 patients in exper

关 键 词：视神经损伤 自然腔道内镜手术 治疗结果 视神经管扩大减压 视柱磨除 

分 类 号：R77[医药卫生—眼科] R651[医药卫生—临床医学]