摘要
目的探讨经鼻内镜视神经减压术治疗外伤性视神经病的疗效以及影响预后的因素。方法回顾性总结中山大学附属第三医院耳鼻咽喉一头颈外科自1995年1月至2001年2月（53例）、自2001年3月至2009年12月（50例）收治的103眼外伤性视神经病的临床特征以及应用经鼻内镜视神经减压术治疗的临床结局，通过单因素分析所检验）和多因素分析（Logistic回归分析1筛选出影响外伤性视神经病外科手术治疗预后的因素，并建立回归方程。结果103眼的手术总有效率为37．86％（39／103）。术前有残余视力者有效率为83．3％（20／241，无残余视力者有效率为24．05％（19／79），比较差异有统计学意义（P〈0．05）。单因素和多因素分析显示术前无残余视力、伤后至手术间隔时间〉3d以及筛蝶窦积血这3个因素与手术效果呈显著相关性（P〈0．051，年龄、有无意识障碍、伤后至手术间隔时间是否〉7d、视神经管有否骨折、是否切开鞘膜、术前是否使用激素等因素与手术效果不相关（P〉0．05），但在有视神经管骨折的患者中，骨折部位和严重程度不同其疗效也有差别。预测手术效果的Logistic回归方程为P（1）=1／[1＋e^-（-2.139＋2.839X3＋1.372X5＋2.263X9]（x3：术前残余视力；X5：外伤至手术间隔时间；X9：筛蝶窦积血1。结论经鼻内镜视神经减压术治疗外伤性视神经病的总体疗效并不令人满意，特别是对于术前无光感者。影响外伤性视神经病外科手术疗效的不良预后因素多且相互影响。临床上应根据患者不同的临床特点慎重选择手术方式。
Objective To investigate the therapeutic efficacy of endoscopic optic nerve decompression （EOND） on patients with traumatic optic neuropathy （TON） and their related prognostic factors. Methods The clinical data of 103 eyes with TON, admitted to our hospital from January 1995 to February 2001 （n=53） and from March 2001 to December 2009 （n=50）, were retrospectively analyzed; the clinical outcomes of these patients after being performed EOND were observed. Univariate analysis （Chi-square test） and logistic regression were performed to analyze the prognostic factors of TON underwent EOND therapy. Results The total effective rate of 103 eyes was 37.86% （39/103）; the effective rate of eyes with residual vision was 83.3% （20/24）, which was significantly higher than that of those without residual vision （24.05%, 19/79, P〈0.05）. Univariate analysis and multiple factor logistic regression, respectively, showed that 3 variables significantly increased the risk of the visual acuity： no residual vision, interval from injury to surgery for more than 3 d and ethmoid and/or sphenoid sinus hematocele after injury. Other factors such as age, disturbance of consciousness, optic canal fracture, performing of sheathotomy, hormone level and interval from injury to surgery for more than 7 d were not correlated with the efficacy （P〉0.05）. Comparing fractures at different sites and with different severities, the efficacy of surgery was also different. The logistic regression equation is P（1）=1/1＋e^-（-2.139＋2.839X3＋1.372X5＋2.263X9]. Conclusion The total therapeutic efficacy of EOND on patients with TON is not satisfactory, especially for those without light perception. The prognostic factors of TON were very complex and interactive; no light perception, interval from injury to surgery for more than 3 d, hemorrhage within the ethmoid and/or sphenoid sinus and lateral or multiple fracture of optic canal are factors affecting the prognosis of EOND for patients with TON. The indication for EOND must be individualized.
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2012年第9期948-953,共6页
Chinese Journal of Neuromedicine
关键词
外伤性视神经病
内窥镜
视神经减压术
预后
影响因素
Traumatic optic neuropathy
Endoscopy
Optic nerve decompression
Prognostic factor
