内镜下视神经管减压术治疗外伤性视神经病变手术前后球后血流的改变及分析

Blood flow changes and analysis in ophthalmic artery and central retinal artery before and after endoscopic transethmosphenoid optic canal decompression in patients with traumatic optic neuropathy

摘要:

摘要：目的??观察分析外伤性视神经病变（TON）患者在内镜下视神经管减压术（ETOCD）治疗前后眼动脉（OA）和视网膜中央动脉（CRA）的血流的改变，探索ETOCD手术的作用机制和TON的病理生理机制。方法?收集连续75例临床确诊为单眼TON并接受ETOCD手术治疗的患者。观察ETOCD治疗前后OA和CRA的收缩期血流峰值速度（PSV）、舒张末期血流速度（EDV）、阻力指数（RI）及术前术后患眼最佳矫正视力（BCVA）的变化。运用Logistic回归分析观察可能影响ETOCD视力预后的因素。结果?①PSV的改变：OA术前患眼较健眼降低（P?<0.05），术后患眼较术前升高（P?<0.05）；CRA术前患眼较健眼降低（P?<0.05），术后患眼较术前升高（P?<0.05）。EDV值：OA术后患眼较术前升高（P?<0.05）；CRA术前患眼较健眼降低（P?<0.05）。RI值：CRA术前患眼较健眼降低（P?<0.05）；②手术治疗后视力均较术前提高（P?<0.05）；③OA术后高PSV值是视力改善的保护因素（OR=1.055，P?<0.05）；患眼CRA术前高PSV值是视力改善的保护因素（OR=1.257，P?<0.05）。结论?ETOCD是治疗TON安全、有效的治疗方法，TON患者患眼OA和CRA的血流速度较正常眼下降，ETOCD术后患眼血流速度较术前改善，这对患者视力预后可能具有保护性作用。

Abstract:

Abstract: Objective?Observe the changes of blood flow in ophthalmic artery (OA) and central retinal artery (CRA) before and after endoscopic transethmosphenoid optic canal decompression (ETOCD) in patients with traumatic optic neuropathy (TON), then explore the possible mechanism of ETOCD surgery and the possible pathophysiological mechanism of TON.?Method?75 consecutive patients who were diagnosed with monocular TON and received ETOCD surgery were collected. We observed the changes of peak systolic velocity (PSV), end diastolic velocity (EDV), Resistive index (RI) and Best corrected visual acuity (BCVA) in OA and CRA before and after ETOCD treatment. Then Logistic regression analysis was used to explore the factors that may affect the prognosis of ETOCD.?Result?Changes of PSV in OA: Lower in injured side than healthy side before surgery (P?