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目的观察神经内镜下经蝶筛窦径路进行视神经减压术治疗外伤性视神经损伤的临床疗效。方法选取2002年1月-2007年12月医院神经外科收治的外伤性视神经损伤患者27例为保守组,行256极速CT眼眶薄层扫描,保守治疗患者予以激素冲击、营养神经及扩张血管等综合药物治疗;选取2008年1月-2013年12月手术治疗的外伤性视神经损伤患者14例,手术患者除保守治疗措施外,行神经内镜下经蝶筛窦视神经管减压术。随访6个月。依据治疗前后视力评分情况,比较2种治疗方案的视力恢复的疗效差异。结果全组病例均随访6个月,手术组视力改善有效率高于保守组(χ2=4.41,P<0.05)。2组治疗后的视力评分均高于治疗前,且手术组高于保守组(P<0.05)。结论神经内镜下经蝶筛窦径路进行视神经减压术治疗外伤性视神经损伤可提高治疗效果。
Objective To observe the clinical efficacy of neurosurgical transsphenoidal approach for optic nerve decompression in the treatment of traumatic optic nerve injury. Methods Twenty-seven patients with traumatic optic nerve injury admitted to Department of Neurosurgery between January 2002 and December 2007 were selected as conservative group. They were scanned by 256-speed CT orbital thin-layer scanning. The patients with conservative treatment were treated with hormonal impact, nourishing nerves and dilating blood vessels 14 patients with traumatic optic nerve injury underwent surgical treatment from January 2008 to December 2013 were selected. In addition to the conservative treatment measures, the patients underwent endoscopic transsphenoidal nerve canal decompression. Follow up for 6 months. According to the visual acuity score before and after treatment, the curative effects of the two kinds of treatment were compared. Results All the patients were followed up for 6 months. The visual acuity improvement rate in the operation group was higher than that in the conservative group (χ2 = 4.41, P <0.05). The visual acuity scores of the two groups after treatment were higher than before treatment, and the surgery group was higher than the conservative group (P <0.05). Conclusion The treatment of traumatic optic nerve injury with neuro endoscopic transsphenoidal approach for optic nerve decompression can improve the therapeutic effect.