鼻内镜下经筛路径眶内侧壁减压治疗甲状腺相关眼病

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1、鼻内镜下经筛路径眶内侧壁减压治疗甲状腺相关眼病［摘要］目的研究经鼻内镜下经筛路径眶内侧壁减压治疗甲状腺相关眼病的可行性和有效性。方法选择2008年1月〜2012年6月广东省云浮市人民医院耳鼻咽喉科住院确诊为甲状腺相关眼病的患者20例(38眼)，采用鼻内镜下经筛路径眶内侧壁眶减压治疗。观察手术前后患者的视力、眼压、眼球突出度及运动度、角膜情况以及有无复视和并发症发生情况。结果术后视力明显提高23眼(60.5%),轻度提高13眼(34.2%),视力保持在4.3〜4.9,无变化2眼(5.3%)；34眼压降低0.2〜20

2、.6mmHg(1mmHg=0.133kPa),4眼变化明显；35眼(92.1%)眼球突出后退1〜4mm,另外3眼无明显变化；术前23眼存在眼球活动受限，其中16眼(69.6%)术后得到一定程度的缓解，7眼无变化；术前7例存在复视，其中术后3例复视消失；除2例术后出现中鼻道出血行止血处理外，其余未发生其他并发症。结论鼻内镜下经筛路径眶内侧壁眶减压术具有创伤小、视野清晰、安全有效的优点，是治疗甲状腺相关眼病理想的术式。［关键词］甲状腺相关眼病；鼻内镜；经筛路径；减压［中图分类号］R765.9［文献标识码］A［文章编号

3、］1673-7210(2013)11(c)-0069-03SurgeryofendoscopictransethmoidpathmedialorbitalwalldecompressionforthetreatmentofthyroidassociatedophthalmopathyCHENGuofenglLIUYilLIANGZhuping2HUYongchenglWANGZhenyinglCAIBangl1.DepartmentofOtolaryngology,People'sHospitalofYunfuC

4、ity,GuangdongProvince,Yunfu527300,China；2.DepartmentofOphthalmology,People，sHospitalofYunfuCity,GuangdongProvince,Yunfu527300,China[Abstract]ObjectiveTostudythepossibilityandeffectivenessofendoscopictransethmoidpathmedialorbitalwalldecompressionforthetreatmen

5、tofthyroidassociatedophthalmopathy.Methods20casesofpatients(〔38eyes)withthyroidassociatedophthalmopathywhowerediagnosedinDepartmentofOtolaryngology,People，sHospitalofYunfuCity,fromJanuary2008toJune2012,wereselectedandtreatedwiththesurgeryofendoscopictransethm

6、oidpathmedialorbitalwalldecompression.Thevision,intraocularpressure，exophthalmicdegreeandeyemovement,cornealconditions,withorwithoutdiplopiaandcomplicationwereobservedbeforeandaftersurgery.Results23eyes(60.5%)withsignificantvisionimprovement,13eyes(34.2%)with

7、mildvisionimprovementwerefound,thevisionwasintherangeof4.3一4・9,2cases(5.3%)withnochangewerefound；therangeofintraocularpressuredecreasein0.2-20.6mmHg(1mmHg=0.133kPa)werefoundin34eyes,4eyeswerefoundwithobviouschanges；therangofexophthalmosretreatin1-4mmwerefound

8、in35eyes(92.1%),noobviouschangeswasfoundin3eyes.Limitationofeyemovementwasfoundin23eyes,theremissionwasfoundin16cases(69.6%),7eyeswerefoundnochange；7eyeswithdiplopiawerefound,diplopiawere