鼻内镜下视神经减压术治疗外伤性视神经损伤临床观察

摘要

目的 探讨鼻内镜下视神经减压术治疗外伤性视神经损伤的临床疗效,并分析其手术预后的相关因素.方法 回顾性分析广东省人民医院耳鼻咽喉科2004年11月～2016年3月期收治且具有完整随访资料的109例(110眼)外伤性视神经损伤患者的临床资料,其中男95例,女14例;年龄6 ～65岁,平均年龄27岁.所有患者均接受鼻内镜视神经减压术,评估手术的临床疗效及预后相关因素.采用SPSS 22.0软件进行统计学分析.结果 所有患者均随访3个月以上,手术的总体视力改善率为55.5％(61/110),其中有效率21.8％(24/110),显效率33.7％(37/110);术前视力有光感者视力改善率达100％(24/24),无光感者为44.2％(38/86);没有病例术后视力较术前变差.手术时间距离受伤时间＜3d者视力改善率为59.5％(22/37),3～7d为53.3％(32/60),＞7d为53.9％ (7/13);术中切开视神经鞘膜者视力改善率为50.0％(4/8),不切开者为55.9％(57/102).单因素分析结果显示,术前视力与患者的手术预后呈显著的正相关(P=0.001).而Logistic回归分析显示,年龄、性别、术前视力、外伤到手术间隔的时间以及术中是否行视神经鞘膜切开均不是影响患者手术预后的显著因素.结论 鼻内镜下视神经减压术是治疗外伤性视神经损伤的有效手段,且外伤至手术的时间及术中是否行鞘膜切开与手术预后无显著相关.%Objective To investigate the curative effect of endoscopic optic nerve decompression for traumatic optic nerve injury and to evaluate the relevant prognostic factors.Methods Clinical data of 109 patients (110 eyes) hospitalized in our department and underwent endoscopic optic nerve decompression due to traumatic optic nerve injury between Nov 2004 and March 2016 were analyzed retrospectively.Of all the 109 patients,95 were male and 14 were female.Their age ranged from 6 to 65 years old with an average of 27.SPSS 22.0 software was used to analyzed the data.Results All the 109 patients (110 eyes) had been followed up for more than 3 months.The total improvement rate was 55.45％ (61/100) including effective rate of 21.8％ (24/110) and obvious effective rate of 33.7％ (37/110).The vision improvement rate in patients with light sensation was 100％ (24/24),and that in patients without light sensation was 44.2％ (38/86).Vision deterioration occurred in none.The improvement rates in patients underwent surgical treatment within 3 days,3-7 days and 8 days or more after injury were 59.46％ (22/37),53.33％ (32/60) and 53.85％ (7/13) respectively.The vision improvement rate in patients with intra-operative incision of optic nerve sheath was 50％ (4/8),while that in those without incision of nerve sheath was 55.88％ (57/102).Univariate analysis showed that there was significantly positive correlation between preoperative vision acuity and therapeutic effect.However,multiple logistic regression analysis identified that gender,age,preoperative vision acuity,the interval from injury to operation and incision of optic nerve sheath were not significantly correlated with the therapeutic effect.Conclusions Endoscopic optic nerve decompression is an effective treatment for traumatic optic nerve injury.The interval from injury to operation and incision of optic nerve sheath are not significantly correlated with the therapeutic effect.