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目的评价内窥镜在治疗视神经损伤中的作用。方法选择13例视神经管内下壁骨折的患者,鼻窥镜引导下中鼻甲切除后1/3,开放蝶窦开口及后组筛窦,辨别骨折的位置以及视神经管、颈内动脉压迹及视神经隐窝,开放视神经眶口及颅口及全长,未剪开视神经鞘膜,2例视神经管颅口处硬膜破裂者,用中鼻甲剪下的黏膜敷于漏口处,一根油纱条填塞于蝶窦及中鼻道,可疑脑脊液漏者7~10 d拔除纱条,其余患者3 d拔除纱条。评价视力的标准为:失明、光感、眼前手动、眼前数指、能见视力表符号5个级别,术后视力提高1个级别以上为有效,视野的改善也为有效。结果术前6例无光感者,5例有效,其余7例有残存光感者均有效,有效率92%。结论经鼻腔内窥镜视神经管减压手术为微创治疗,对视神经可全程减压,对视神经干扰小,术后恢复快。
Objective To evaluate the role of endoscopy in the treatment of optic nerve injury. Methods Thirteen patients with lower extremity wall fracture of the optic canal were selected. One third of the middle turbinate was excised under nasal speculum. The sphenoid sinus opening and posterior ethmoid sinus were opened. The position of the fracture and the optic canal, internal carotid artery and optic nerve Crypt, open optic nerve orbital mouth and cranial mouth and full-length, not cut open the optic nerve sheath, 2 cases of optic canal rupture of the dura at the cranium, with middle turbinate cut mucosa applied to the leak, an oil yarn Striped in the sphenoid sinus and middle nasal passages, suspicious cerebrospinal fluid leakage were removed 7 ~ 10d gauze, the remaining patients 3d removal of gauze. The criteria for evaluating visual acuity were: blindness, light sensation, manual in front of me, fingers in front of me, 5 levels of visual acuity chart visible, effective visual acuity increased by 1 level or above, and visual field improvement also effective. Results There were 6 cases without light sensation before operation, 5 cases were effective, the rest 7 cases were residual light sensation were effective, the effective rate was 92%. Conclusion Transnasal endoscopic optic canal decompression surgery for minimally invasive treatment of the entire optic nerve decompression, the optic nerve interference small, fast recovery.