内镜辅助下经鼻入路眼眶减压术的研究进展

doi:10.3969/j.issn.1674-8115.2021.12.021

摘要/Abstract

摘要：

随着内镜技术的发展，使用内镜辅助下经鼻入路行眼眶减压术已成为一种成熟的手术方式。鼻入路利用天然存在的窦腔，避免了手术瘢痕；内镜可延伸手术视野，清晰显示手术区域，降低手术风险。许多研究表明内镜辅助下经鼻入路眼眶减压术后，眼球突出度改善，并且未发生严重并发症。在使用内镜辅助行眼眶减压时可选择不同的手术方案，相应的减压效果和并发症有所不同。该文综述在甲状腺相关眼病患者的治疗中，内镜辅助下经鼻入路的各类眼眶减压术的应用以及其有效性和安全性。

关键词: 内镜, 甲状腺相关眼病, 眼眶减压术

Abstract:

Endoscopic orbital decompression has become a mature surgical method because of the development of endoscope. The surgery through transnasal approach makes use of the natural sinus to avoid surgical scar and the endoscope visualizes the surgical area to reduce the risk. Many studies have demonstrated that transnasal endoscopic orbital decompression can reduce the proptosis and cause no severe complications. Using endoscope to apply transnasal orbital decompression has many operation schemes, which may have influence on the result of surgery and the occurrence of complications. This review is to introduce the application of endoscope to orbital decompression and its effectiveness and safety.

Key words: endoscope, thyroid-associated ophthalmopathy, orbital decompression

中图分类号:

R775.9

孙柔, 周慧芳. 内镜辅助下经鼻入路眼眶减压术的研究进展[J]. 上海交通大学学报(医学版), 2021, 41(12): 1692-1697.

Rou SUN, Hui-fang ZHOU. Research progress of endoscope-assisted transnasal orbital decompression[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(12): 1692-1697.

图/表 3

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Author	Year	Patients	Approach	Subjects	Removed Orbital Wall	Proptosis reduction/mm	Visual acuity	New on-set diplopia	Complications
Eloy P， et al.^［20］	2000	TAO	Transnasal	16 patients 27 orbits	Medial	3.17	0.80→0.95	50.0% （8/16）	‒
Juniat V， et al.^［21］	2019	Inactive TAO or active TAO without DON	Transnasal	24 orbits	Medial	3.50	No vision loss	‒	No other complications
Lv ZG， et al.^［22］	2016	DON	Transnasal	43 patients 72 orbits	Medial	6.20	An improvement of 0.55	11.6% （5/43）	No other complications
Wu WC， et al.^［23］	2015	Inactive TAO	Transnasal	108 patients 206 orbits	Medial	8.20	‒	23.1% （25/108）	17.6% epistaxis，1.9% intraorbital hemorrhages and 2.7% orbital emphysema
Hernández-García E， et al.^［24］	2017	Inactive TAO or DON	Transnasal and Transcutaneous	20 patients 36 orbits	Medial and Lateral	3.50	DON：0.40→0.80	15.0% （3/20）	5.0% post-operative epistaxis and 5.0% cerebrospinal fluid leak
Unal M， et al.^［25］	2000	Inactive TAO or DON	Transnasal and Transcutaneous	9 patients　14 orbits	Medial and Lateral	4.80	Improvement in 2 DON patients	22.2% （2/9）	No other complications

Author	Year	Patients	Approach	Subjects	Removed Orbital Wall	Proptosis reduction/mm	Visual acuity	New on-set diplopia	Complications
Eloy P， et al.^［20］	2000	TAO	Transnasal	16 patients 27 orbits	Medial	3.17	0.80→0.95	50.0% （8/16）	‒
Juniat V， et al.^［21］	2019	Inactive TAO or active TAO without DON	Transnasal	24 orbits	Medial	3.50	No vision loss	‒	No other complications
Lv ZG， et al.^［22］	2016	DON	Transnasal	43 patients 72 orbits	Medial	6.20	An improvement of 0.55	11.6% （5/43）	No other complications
Wu WC， et al.^［23］	2015	Inactive TAO	Transnasal	108 patients 206 orbits	Medial	8.20	‒	23.1% （25/108）	17.6% epistaxis，1.9% intraorbital hemorrhages and 2.7% orbital emphysema
Hernández-García E， et al.^［24］	2017	Inactive TAO or DON	Transnasal and Transcutaneous	20 patients 36 orbits	Medial and Lateral	3.50	DON：0.40→0.80	15.0% （3/20）	5.0% post-operative epistaxis and 5.0% cerebrospinal fluid leak
Unal M， et al.^［25］	2000	Inactive TAO or DON	Transnasal and Transcutaneous	9 patients　14 orbits	Medial and Lateral	4.80	Improvement in 2 DON patients	22.2% （2/9）	No other complications

Author	Year	Patient	Approach	Subject	Removed orbital wall	Proptosis reduction /mm	Visual acuity	New on-set diplopia	Complications
Lal P， et al.^［29］	2013	Inactive TAO or DON	Transnasal	12 patients 24 orbits	Medial and inferior （strut removed）	3.70	Improved significantly in 50.0% orbits with DON	100% （resolved over the next 8 weeks）	8.3% unilateral frontal sinus obstruction
Baradaranfar MH， et al.^［30］	2004	Active or inactive TAO（one DON）	Transnasal	21 patients 42 orbits	Medial and inferior （strut removed）	4.10	Not DON 0.50→0.67 DON OS：HM→0.13 OD：0.25→0.33	71.4% （15/21）	‒
Malik R， et al.^［31］	2008	Inactive TAO	Transnasal	15 patients 20 orbits	Medial and inferior （strut unremoved）	3.70	‒	26.7% （4/15）	6.7% sinusitis and 6.7% post-operative rhinorrhoea
Shi WJ， et al.^［32］	2015	Active or inactive TAO （no DON）	Transnasal and Transcutaneous	6 patients　12 orbits	Medial inferior and lateral （strut removed）	6.41	0.23→0.48	50.0% （3/6）（recovered in 3-5 months）	‒
Cansiz H， et al.^［33］	2006	Active or inactive TAO（one DON）	Transnasal and Transcutaneous	7 patients 8 orbits	Medial inferior and lateral （strut unremoved）	7.75	2 eyes 0.70→1.00 1 eye 0.80→1.00 No change in other 5 eyes	14.3% （1/7）	14.3% maxillary sinusitis

Author	Year	Patient	Approach	Subject	Removed orbital wall	Proptosis reduction /mm	Visual acuity	New on-set diplopia	Complications
Lal P， et al.^［29］	2013	Inactive TAO or DON	Transnasal	12 patients 24 orbits	Medial and inferior （strut removed）	3.70	Improved significantly in 50.0% orbits with DON	100% （resolved over the next 8 weeks）	8.3% unilateral frontal sinus obstruction
Baradaranfar MH， et al.^［30］	2004	Active or inactive TAO（one DON）	Transnasal	21 patients 42 orbits	Medial and inferior （strut removed）	4.10	Not DON 0.50→0.67 DON OS：HM→0.13 OD：0.25→0.33	71.4% （15/21）	‒
Malik R， et al.^［31］	2008	Inactive TAO	Transnasal	15 patients 20 orbits	Medial and inferior （strut unremoved）	3.70	‒	26.7% （4/15）	6.7% sinusitis and 6.7% post-operative rhinorrhoea
Shi WJ， et al.^［32］	2015	Active or inactive TAO （no DON）	Transnasal and Transcutaneous	6 patients　12 orbits	Medial inferior and lateral （strut removed）	6.41	0.23→0.48	50.0% （3/6）（recovered in 3-5 months）	‒
Cansiz H， et al.^［33］	2006	Active or inactive TAO（one DON）	Transnasal and Transcutaneous	7 patients 8 orbits	Medial inferior and lateral （strut unremoved）	7.75	2 eyes 0.70→1.00 1 eye 0.80→1.00 No change in other 5 eyes	14.3% （1/7）	14.3% maxillary sinusitis

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