论文部分内容阅读
鞍区占位手术前后视力分析太原市中心医院（０３０００９）陈跃红，柴亨利鞍区占位主要表现为视力的改变及内分泌功能改变，我们对近五年收治的９例鞍区占位病变患者的手术前后视力改变进行了分析，现报道如下：临床资料本组男６例，女３例。年龄８～５６岁，平均４１岁。垂体腺瘤７例，颅咽管瘤１例，鞍结节脑膜瘤１例。全部病例行经颅入路行肿瘤切除视神经减压术。手术前及术后２周均行视力及视野（周边视力）检查，视力采用对数、分数两用视力表，视野采用弧形视野计检查法，视标统一为红色小视标。９例患者１８眼术前检查，６眼失明，视神经均已萎缩；其余１２眼术前平均视力４．０７，术后平均视力４．６０，平均提高０．４６±０．０９（Ｐ＜０．０１）。该１２眼周边视力，视野图颞侧偏盲８眼，管形视野４眼；术后８眼颞侧偏盲范围缩小，管形视野恢复不明显。讨论鞍区占位患者视力障碍是由于肿瘤突破鞍隔后向上发展直接压迫视神经、视交叉或视束所致；或者肿瘤压迫基底动脉和前交通动脉，使视交叉和神经血运受到影响所致。９例患者行视神经减压术后，加用神经营养药物，视力明显提高，但视神经萎缩后视力不易恢复。当肿瘤自下而上压迫视交叉的正中部分即出现颞测偏盲，我们认为有色视标及小视标
Visual acuity before and after surgery in the saddle area operation Taiyuan Central Hospital (030009) Chen Yuehong, Chai Henry Lee saddle area mainly for visual acuity changes and changes in endocrine function, we admitted to the past five years in 9 patients with saddle-space lesions Changes in visual acuity before and after surgery are reported as follows: Clinical data The group of 6 males and 3 females. Age 8 to 56 years old, average 41 years old. Pituitary adenoma in 7 cases, 1 craniopharyngioma, saddle nodular meningioma in 1 case. All cases underwent transcranial approach for tumor resection and optic nerve decompression. Visual acuity and visual acuity (peripheral visual acuity) were examined before surgery and 2 weeks after surgery. Visual acuity was measured by logarithmic and fractional acuity chart. Visual field was visualized by arc-field test. Nine of the 18 patients underwent preoperative examination, 6 were blind and the optic nerve atrophy was observed. The average preoperative visual acuity was 4.07 and the average postoperative visual acuity was 4.60 (average 0.46 ± 0.09, P <0 .01). The visual acuity of the 12 eyes, temporal hemianopia in the field of vision in 8 eyes, tubular field of vision in 4 eyes; postoperative 8 eyes temporal hemianopia narrowing range, tubular visual field recovery was not obvious. Discussion of saddle area occupying patients with visual impairment due to the development of the tumor after the break up of the septum directly oppression of the optic nerve, optic chiasm or optic tract caused by; or tumor compression of the basilar artery and anterior communicating artery, the optic chiasm and neurotransmission are affected . Nine patients underwent optic nerve decompression, plus neurotrophic drugs, visual acuity was significantly improved, but visual acuity was not easy to recover after atrophy. When the tumor from the bottom up oppression of the middle part of the optic chiasm temporal hemimorphosis, we believe that the colored optometrists and small optometrists