摘要
目的评价鼻源性视觉碍障性疾病的诊断及经鼻内镜手术治疗的临床疗效。方法回顾性分析36例（36眼）鼻源性视觉障碍性疾病患者的临床资料，均行鼻内镜下鼻腔鼻窦探查＋鼻窦开放术，其中10眼行视神经管减压术。结果36例中诊断双侧全组鼻窦炎7例，单侧后组筛窦、蝶窦炎9例，孤立性蝶窦炎8例，单侧后组筛窦、蝶窦真菌病8例，单侧蝶窦、筛囊肿或脓囊肿3例，额窦、筛窦炎1例，均经术后病理证实。术前视功能：无光感3眼，眼前手动10眼，眼前指数（〈20cm）11眼，另外12眼有不同程度视力下降。术后视功能：无改善3眼；恢复到发病前水平13眼；由术前眼前手动、眼前指数改善到指数（30-60cm）20眼，有效率为91.7％（33／36）。其他眼部症状消失。全部患者术后鼻窦术腔上皮化。结论鼻源性视觉障碍性疾病患者若药物保守治疗无效，应及早行鼻内镜下鼻腔鼻窦探查＋鼻窦开放术。对严重视觉障碍、视力急剧下降患者应尽早实施视神经管减压术，可有效改善患者的视功能。
Objective To evaluate the diagnosis and efficiency of nasal endoscopic surgery treatment for rhinogenous optic function damage （ROFD）. Methods The clinical data of 36 patients （36 eyes） with ROFD were retrospectively reviewed. All patients were operated on nasa/sinus probing and open sinus surgery through transnasal endoscopic approach,and 10 patients underwent endoscopic optic nerve decompression. Results Seven patients had bilateral pansinusitis,9 patients had unilateral posterior ethmoidal sinusitis and sphenoiditis, 8 patients had isolated sphenoiditis, 8 patients had fungal sinusitis occured in the sphenoid sinus and unilateral posterior ethmoid sinus, 3 patients had unilateral pyocyst and cyst of the sphenoid and ethmoid sinus, 1 patient had frontal and ethmoidal sinusitis. All patients were confirmed by pathology after surgery. The visual acuity preoperative were as follows：3 eyes no light perception, 10 eyes hand movement, 11 eyes fingers counting less than 20 cm and 12 eyes were vision impaired in different degree.The visual acuity postoperative were as follows ： 3 eyes failed, 13 eyes cured, 20 eyes improved from hand movement or fingers counting to fingers counting （30-60 cm）. The efficiency rate was 91.7% （33/36）. The other eye symptom was disappeared. Sinus epithelization was happened after surgery in all patients. Conclusions If the medicine expectant treatment is invalid, nasal sinus probing and open sinus surgery through transnasal endoscopic approach should be performed early in treatment of ROFD. Patients who suffered from severe visual damage and either unresponsive or intolerant to medical treatment should be administrated endoscopic sinus surgery including endoscopic optic nerve decompression.
出处
《中国医师进修杂志》
2013年第24期23-25,共3页
Chinese Journal of Postgraduates of Medicine
关键词
视觉障碍
视神经炎
内窥镜检查
减压术
外科
Vision disorders
Optic neuritis
Endoscopy
Decompression, surgical
