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目的探讨经鼻内镜下视神经减压术治疗管段视神经损伤的可行性、技巧及优点。方法回顾性分析39例视神经损伤的病例,伤后2～18d行手术治疗,采用鼻内镜下经鼻视神经减压术,经筛窦或蝶窦自然开口进入蝶窦,寻找视神经管及骨折部位,去除骨管周壁的1/3～1/2,切开视神经鞘膜,明胶海绵及凡士林纱条填塞鼻腔,术后给予药物、高压氧治疗。结果随访至少3个月,39例患者(40眼)中,5例失访,术后视力改善的总有效率为52.5%(21/40)。受伤至手术的时间间隔2～7d手术者,术后视力改善的有效率为58.6%(17/29);7～18d手术者,术后视力改善的有效率为36.4%(4/11)。视力恢复期约2个月。结论经鼻内镜下视神经减压术具有视野清晰,无需开颅,侵袭性小,头面部不遗留瘢痕,并发症少等优点,手术恢复的程度与视神经损伤的程度、手术时间的选择及手术技巧等因素相关。
Objective To investigate the feasibility, technique and advantages of optic nerve decompression under nasal endoscope in the treatment of optic nerve injury in the segment. Methods Thirty-nine cases of optic nerve injury were retrospectively analyzed. Surgical treatment was performed from 2 to 18 days after injury. Nasal optic nerve decompression was performed under nasal endoscopy to enter the sphenoid sinus via the ethmoid sinus or sphenoid sinus, looking for the optic canal and the fracture site , Remove the periostral wall of 1/3 ~ 1/2, cut the optic nerve sheath, gelatin sponge and vaseline gauze packing nasal cavity, postoperative medication, hyperbaric oxygen therapy. Results The patients were followed up for at least 3 months. Among the 39 patients (40 eyes), 5 were lost to follow-up. The total effective rate of postoperative visual acuity improvement was 52.5% (21/40). The effective rate of postoperative visual acuity improvement was 58.6% (17/29) in patients who were injured between 2 and 7 days after operation. The effective rate of postoperative visual acuity improvement was 36.4% (4/11) in 7 to 18 days. Vision recovery period of about 2 months. Conclusion The transnasal endoscopic decompression has the advantages of clear vision, no need of craniotomy, little invasiveness, scarless scarring on head and face, few complications, degree of recovery of operation and degree of optic nerve injury, choice of operation time and operation Skills and other factors related.