内窥镜下经蝶筛径路视神经减压术联合激素及神经生长因子治疗短期外伤性视神经病变

Outcome of endoscopic trans-ethmosphenoid optic canal decompression combined with steroid and nerve growth factor therapy for short-time traumatic optic neuropathy

摘要:

目的：介绍内窥镜下经筛蝶径路视神经减压术治疗短期外伤性视神经病变的临床效果。

方法：回顾性研究151例首诊小于5d的外伤性视神经病变患者，所有患者入院后用甲基强的松针治疗3d，其中117名患者激素治疗后视力无显著提高。术后对激素治疗后视力无显著提高患者局部和全身使用激素和神经生长因子。根据术前视力，患者分为A组(无光感组)和B组(有残余视力组)。

结果：117例激素治疗后视力无显著提高患者中，70例视力有提高，有效率为59.8%。A组和B组有效率分别为44.8%和80.0%。B组有效率显著高于A组(χ²=14.781， P<0.05)。

结论：内窥镜下经筛蝶径路视神经减压术联合激素和神经生长因子治疗短期外伤性神经病变可能是一种有效的治疗方法，术前有残余视力患者疗效好于无光感患者。然而，对于无光感患者也可能通过此治疗提高视力。

Abstract:

AIM: To present the efficacy of Endoscopic trans-ethmosphenoid optic canal decompression(ETOCD)combined with steroid and nerve growth factor(NGF)therapy in patients with short-time traumatic optic neuropathy(TON).

METHODS: A retrospective analysis of 151 TON patients(151 eyes)were performed. Their first treatment were all initiated within 5 days of injury. All patients were treated with methylprednisolone for 3 days. There were 117 patients did not improve with methylprednisolone treatment were offered ETOCD. Local and systemic administration of steroid and NGF were given to them after surgery. According to the visual acuity(VA)preoperatively, all patients who underwent surgery were divided into Group A \〖no light perception(NLP)\〗 and Group B(with residual vision).

RESULTS:VA was improved in 70 of 117 patients after surgery, with a total efficacy of 59.8%. The effective rate of Group A and B were 44.8% and 80.0% respectively. Group B had significantly higher effectiveness rate than Group A(χ²=14.781, P<0.05).

CONCLUSION: ETOCD combined with steroid and NGF may be an useful way to improve VA in short-time TON patients. Patients with preoperative residual vision had better prognosis in VA postoperatively. However, NLP patients may benefit from surgery as well.