CAJ | 학술논문

目的探讨鼻内镜鼻窦手术的眼部并发症可能的原因及处理经验,以期引起鼻内镜外科医生的重视.方法收集作者收治的具有比较典型特征的鼻窦手术眼部并发症者22例8类.损伤类型分别为:纸样板损伤、眶内感染、额筛阻塞性囊肿、泪道损伤、眼外肌损伤、眶内出血、视神经损伤、眼底动脉栓塞等,并给予了相应处理.结果单纯纸样板损伤9例中8例经保守治疗痊愈,眶纸样板损伤伴眶骨膜下感染1例和泪道损伤、额筛阻塞性囊肿各1例经鼻内镜手术痊愈.眼外肌损伤2例中1例经眼肌矫正术后除向健侧有轻微复视外,其他眼位无明显复视;另1例经眼肌矫正后仍有轻度复视.眶纸样板损伤致眶内出血1例痊愈,另1例眶内出血和1例眼底动脉栓塞导致的视力丧失无改善.视神经损伤6例(7侧)中1例(1侧)经视神经减压+眶尖减压视力恢复正常,另1侧及其余5例(5侧)无改善.结论鼻内镜手术导致视神经损伤、眶内出血和眼底动脉栓塞导致的失明,治疗困难,预后极差;如果有残存视力,预后较好.
목적 탐토비내경비두수술적안부병발증가능적원인급처리경험,이기인기비내경외과의생적중시.방법 수집작자수치적구유비교전형특정적비두수술안부병발증자22례8류.손상류형분별위:지양판손상、광내감염、액사조새성낭종、루도손상、안외기손상、광내출혈、시신경손상、안저동맥전새등,병급여료상응처리.결과 단순지양판손상9례중8례경보수치료전유,광지양판손상반광골막하감염1례화루도손상、액사조새성낭종각1례경비내경수술전유.안외기손상2례중1례경안기교정술후제향건측유경미복시외,기타안위무명현복시;령1례경안기교정후잉유경도복시.광지양판손상치광내출혈1례전유,령1례광내출혈화1례안저동맥전새도치적시력상실무개선.시신경손상6례(7측)중1례(1측)경시신경감압+광첨감압시력회복정상,령1측급기여5례(5측)무개선.결론 비내경수술도치시신경손상、광내출혈화안저동맥전새도치적실명,치료곤난,예후겁차;여과유잔존시력,예후교호.
Objective To investigate the possible reasons and the treating expefiences of ophthalmic complications in order to elevate the attention of the nasal endoscopic surgeon.Methods This study was involved 8 categories in 22 cases which had typical characteristic of ophthalmic complications of endoscopic sinus surgery,including injury of lamina papyracea,obstructive cyst of frontal and ethmoid sinuses,orbital infection,injuries of lacrimal passages,injury of extraocular muscles,orbital hemorrhage,optic nerve injury and arterial embolism of optic fundi.The patients were given corresponding treatment.Results Injury of lamina papyracea Was cured by medical treatment while orbital infection,injury of lacrimal passages,obstructive cyst of frontal and ethmoid sinuses were completely recovered by endoscopic surgery.In one of the cases,the injured optic nerve had recovered after transnasal optic and orbital apex decompression but the other 6 sides of 6 patients had not been improved.In one case who had suffered from injury of extraocular muscles,their diplopia isappeared mostly.but the other cases had a slight diplopia after surgery.One case who had visual descending caused by orbital hemorrhage recovered.Two cases of visual loss caused by intraorbital hemorrhage and arterial embolism of optic fundi respectively were not improved. Conclusions It is very difficult to cure if the patients lose the sight because of optic nerve injury,orbital hemorrhage and the ischemia of orbit,however.if the patients had remnant vision the prognosis should be much better.