山东大学耳鼻喉眼学报 ›› 2011, Vol. 25 ›› Issue (6): 52-.

• 论文 • 上一篇    下一篇

眶悬带技术在内镜眶减压术中的应用

张维天,程付伟, 张玉君, 朱华明,郭金宝,殷善开   

  1. 上海交通大学附属第六人民医院耳鼻咽喉科, 上海 200233
  • 收稿日期:2011-10-15 修回日期:2011-11-02 出版日期:2011-12-16 发布日期:2011-12-16
  • 通讯作者: 殷善开,男,博士生导师,主任医师。 Email: yinshankai@china.com
  • 作者简介:张维天,博士,副主任医师,硕士生导师,主要从事鼻颅底科学的基础与临床方面的研究。
  • 基金资助:

    上海市卫生局科研课题(2008163)

Endonasal endoscopic orbital decompression: Primary experience of the orbital sling technique

ZHANG Wei-tian, CHENG Fu-wei, ZHANG Yu-jun, ZHU Hua-ming, GUO Jin-bao, YIN Shan-kai   

  1. Department of Otorhinolaryngology, the No.6 People′s Hospital Affiliated to
    Shanghai Jiaotong University, Shanghai 200233, China
  • Received:2011-10-15 Revised:2011-11-02 Online:2011-12-16 Published:2011-12-16

摘要:

目的   总结在经鼻内镜眶减压术中应用眶悬带技术,以降低术后复视发生率的初步经验。方法   6例共11眼行经鼻内镜眶壁减压术。其中包括5例(10眼)Graves眼病和1例(1眼)外伤后病例,手术采用眶悬带技术,即保留眼眶内壁赤道高度条带状眶骨膜以稳定内直肌及眼球,避免其过度疝入眶内而改变其运动矢量。对比术前、术后眼球突出度、复视、眼痛、结膜充血等变化。结果   术后患者眼球突出度减少2~5mm,平均回缩3.2mm。术前2例存在复视,术后复视减轻,其余4例无术后复视发生。5例Graves眼病患者眼胀痛消失,结膜充血减轻,眼球活动度及外观改善。1例外伤病例双眼突出度接近,外观改善。结论   在经鼻内镜眶减压术中保留位于内直肌内侧的条带样眶骨膜,使之成为稳定内直肌及眼球的悬带。该技术能够在保证眶脂肪自悬带上下方溢出而减压的同时,可有效预防术后复视的发生。

关键词: 甲状腺相关眼病;鼻内镜外科手术;眶减压术;复视;突眼

Abstract:

Objective   To evaluate the method and effect of the orbital sling technique in reducing the incidence of diplopia following endoscopic orbital decompression. Methods   Endoscopic orbital decompression was performed on 11 orbits in 5 patients with proptosis from Graves disease and 1 patient from a traumatic case. The orbital sling technique, which tailors a horizontal strip of orbital periosteum, was used to prevent prolapse of the medial rectus muscle. Results   No patients developed new-onset diplopia following the surgery. Of the 2 patients with pre-existing diplopia from the orbitopathy, double vision was improved in both patients and unchanged in the remaining four patients. The mean reduction in proptosis was 3.2mm. Conclusions   The preservation of a periosteum sling overlying the medial rectus muscle during endoscopic orbital decompression may reduce the incidence of post-operative diplopia, while still allowing for a satisfactory reduction in proptosis.

Key words:  Graves ophthalmopathy; Endoscopic surgical procedures, operative; Orbital decompression; Diplopia; Proptosis

中图分类号: 

  • R777.4
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