经鼻内镜视神经减压术治疗外伤性视神经病

Diagnosis and treatment of traumatic optic neuropathy treated by transnasal endoscopic optic nerve canal decompression

摘要:

目的 探讨经鼻内镜视神经减压术治疗外伤性视神经病（TON）的临床疗效及相关预后因素。方法 回顾性分析深圳市龙岗区耳鼻咽喉医院2015—2018年21例TON患者经过大剂量激素冲击治疗无效后经鼻内镜行视神经减压术，术后以提高患者视力级别作为判断临床疗效的标准。结果 术后常规予抗生素及激素、改善循环、营养神经等药物治疗，所有患者随访6个月，14例术前无光感，术后有效6例，有效率42.9%。7例术前有残余光感，术后有效5例，有效率71.4%。伤后7 d内手术13例，术后有效9例，有效率69.2%。伤后7 d后手术8例，术后有效2例，有效率25.0%。结论 经鼻内镜视神经减压是治疗TON的有效方式，患者术前是否有残余光感及手术时机选择是否在7 d内对预后至关重要。

Abstract:

Objective To investigate the clinical efficacy and prognostic factors of transnasal endoscopic optic nerve decompression in the treatment of traumatic optic neuropathy (TON). Methods Retrospective analysis was performed on 21 TON patients in Longgang Otolaryngology Hospital of Shenzhen City from 2015 to 2018.And these patients had received neural tube decompression via nasal endoscopy after high-dose hormone therapy failed. The improvement of visual acuity was used as the criterion to judge the clinical efficacy. Results Postoperative with the treatments of routine antibiotics to prevent infection, hormones, improve circulation, nutrition and other drug, all patients were followed up for 6 months.There were 6 cases of postoperative effective for 14 cases of preoperative no light, and the effective rate was 42.9%; Seven cases with residual light sensation before operation, 5 cases of them had effective after operation, and the effective rate was 71.4%. The 13 cases operated within 7 days after injury, 9 cases of them were effective, and the effective rate was 69.2%. Injuries of 8 cases were operated after 7 days,2 cases of them were effective, and an effective rate was 25.0%. Conclusions Transnasal endoscopic optic nerve decompression is an effective way for the treatment of TON. The presence of residual light perception and the timing of surgery within 7 days are critical to the prognosis.