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目的:探讨管内段损伤性视神经病变的治疗方法。方法:对138例视神经挫伤患者分别采用保守治疗(89例)、鼻外筛蝶窦进路视神经管减压术(21例)及鼻内镜下视神经管减压术(28例)。结果:随访6～18个月。保守治疗:显效24例,有效30例,有效率60.7%;鼻外进路手术:治愈2例,显效6例,有效6例,有效率66.7%;鼻内镜下手术:治愈1例,显效11例,有效9例,有效率75.0%。结论:管内段损伤性视神经病变可首先选择冲击治疗,有效者可继续保守治疗,无效则应及时手术;鼻内镜下视神经管减压术安全、快捷、有效,应作为首选术式。用药及手术时间越早越好,残余视力越好,预后越好。
Objective: To explore the treatment of intracranial lesions of optic neuropathy. Methods: One hundred and thirty-eight patients with optic nerve contusion were treated conservatively (n = 89), optic nerve canal decompression (n = 21) and endoscopic optic nerve decompression (n = 28). Results: Follow-up ranged from 6 to 18 months. Conservative treatment: effective in 24 cases, effective in 30 cases, the effective rate of 60.7%; nasal approach surgery: cured 2 cases, markedly effective in 6 cases, effective 66.7%; endoscopic surgery: cured in 1 case, markedly effective 11 cases, effective in 9 cases, effective rate of 75.0%. CONCLUSIONS: Traumatic optic neuropathy may be the first choice of shock treatment, effective treatment may continue conservative treatment should be timely and ineffective; endoscopic optic canal decompression surgery is safe, fast and effective, should be used as the preferred surgical approach. The sooner the better medication and surgery, the better the residual vision, the better the prognosis.