[Transnasal endoscopic optic nerve decompression for traumatic optic neuropathy: analysis of 155 cases].
[Transnasal endoscopic optic nerve decompression for traumatic optic neuropathy: analysis of 155 cases].
复制标题
经鼻内镜视神经减压术治疗外伤性视神经病变155例分析
DOI：
10.3760/cma.j.issn.0376-2491.2009.06.011
复制
发表时间：
2009
影响因子：
--
通讯作者：
Geng Xu
中科院分区：
文献类型：
--
作者：
K. Zuo;Jian;W. Wen;He;Xiang;Geng Xu
目的
目的探讨鼻内镜下视神经减压术治疗外伤性视神经病变的疗效。
方法
回顾性分析连续155例大剂量激素治疗失败后接受TEOND治疗的TON患者的临床资料，随访后总结其预后，并采用Logistic回归分析其预后相关信息，探讨影响预后的因素。
结果
术后随访3 ~ 60个月。155例患者的总有效率为44.5%。有光感或视力较好者的有效率为87.5%，明显高于无光感者的有效率（29.6%）。69例患者术后视力均有提高，主要发生在术后1 ~ 5d，持续时间1 ~ 3个月。外伤后残余视力程度（OR = 0.04）和损伤与手术间隔时间（OR = 4.62）是影响总体疗效的重要预后因素（P < 0.01），以及逐渐或立即的视力丧失史（OR = 0.22）和损伤与手术的间隔时间（OR = 6.34）对无光感患者的预后有显著影响（P < 0.05）。性别、年龄、昏迷时间、术前术后激素治疗时间、术者、视神经管骨折部位、神经鞘切口与预后无相关性（均P > 0.05）。术中脑脊液漏和术后一过性视力丧失分别发生在一个和其他两个案件，但这些条件都得到了成功解决。
结论
TEOND对TON患者是有效和安全的，但对立即失明的病例视力效果较差。该手术适用于有一定残余视力或视力逐渐丧失的患者，建议在伤后7天内尽早进行。
OBJECTIVE
To explore the outcome of transnasal endoscopic optic nerve decompression (TEOND) for traumatic optic neuropathy (TON).
METHODS
The clinical data of 155 consecutive patients with TON treated with TEOND after failure of mega-dose steroid therapy were retrospectively analyzed, their outcomes were summarized after follow-up, and then Logistic regression was used to analyze the prognosis-related information to explore the factors influencing prognosis.
RESULTS
Patients were followed up for 3 - 60 months. The total effective rate of the 155 patients was 44.5%. The effective rate of the patients with light perception or better vision was 87.5%, much higher than that of the patients without light perception (29.6%). Eyesight was improved, mostly occurring 1 - 5 days after operation and lasting for 1 - 3 months, in 69 patients. Residual vision degree after trauma (OR = 0.04) and the interval between injury and surgery (OR = 4.62) were significant prognostic factors of the general effect (P < 0.01), and the gradual or immediate visual loss history (OR = 0.22) and the interval between injury and surgery (OR = 6.34) were significant to the outcomes of the patients with no light perception (P < 0.05). Sex, age, duration of coma after trauma, pre- and post-operative duration of steroid treatment, operators, fracture site of optic canal, and nerve sheath incision were not correlated to the outcomes of patients (all P > 0.05). Intraoperative cerebrospinal fluid rhinorrhea and postoperative transient visual loss occurred in one and the other two cases, respectively, but these conditions were resolved successfully.
CONCLUSION
TEOND is effective and safe for TON patients, but the visual outcome is poor for the immediate blindness cases. The surgery is indicated for the patients with some residual vision or with a gradual visual loss and is suggested to perform early within seven days after injury.