鼻内镜术致失明的预防和处理（附3例报告）

目的：探讨鼻内镜术致失明的预防和处理。方法：报告3例慢性鼻窦炎和鼻息肉患者于鼻内镜手术中损伤眼部结构和碘仿凡士林纱条填塞后并发的失明及其处理方法。结果：3例中2例因鼻内镜手术时损伤同侧眶内壁纸板和眶内组织结构，术中1例眼球变形、失明，立即行眶内视神经探查和眼内肌修复；1例出现眶周肿胀、眼睑淤血和睑结膜水肿，术后2d失明，清除眶内血肿及行视神经减压术。另1例术中筛窦填塞立即失明，抽出填塞物视力恢复。术后3例患者静脉用大剂量抗生素、糖皮质激素和神经生长因子治疗4周。随访6个月1例视力正常；1例失明，眼球萎缩；1例光感。结论：鼻内镜手术损伤眶内容物和出血，是失明的原因；术前CT检查示后筛窦呈过度气化者，术中应注意视神经骨管是否缺损；确认眶纸板损伤者一般不宜行鼻腔填塞；术后视力下降明显者应立即行视神经减压。

Prevention and management of blindness following endonasal sinus surgery

Objective:To explore the causes and the management of serious eye complications occurring in the endoscopic sinus surgery.Method:Three patients of chronic sinusitis and nasal polyps suffered with blindness in endoscopic sinus surgery and in nasal packing with iodoform and petrolatum gauze were treated.Result:Orbital wall and structure were injured in 2 cases during endoscopic sinus surgery,among which,1 case blinded with deformation of the eyeball during operation underwent optic nerve exploration and orbit...