CAJ | 학술논문

目的探讨视神经不离断的眼内容物剜除并Ⅰ期义眼台置入术的临床疗效.方法对122例患者(122只眼)随机分成A、B两组,术中均先行常规眼内容物剜除术,自颞上至鼻下象限斜行剪开巩膜全层,剖分巩膜壳为两瓣,并放置HA义眼台.两组术中处理视神经的方式不同:A组为传统球后视神经离断,B组为沿视乳头周围2 mm做圆形巩膜剪开.对术中止血时间、球结膜缝合张力、疼痛、义眼台置入后睑裂大小、手术时间；对术后疼痛、球结膜水肿和充血、义眼片佩戴时间行对比分析.结果 A、B两组术中压迫止血时间分别为(23.46±6.96) min和(5 49±1.72)min,球结膜缝合张力评分分别为3.39±0.74和0.45±0.59,手术时间分别为(79.44±10.81) min和(43.46±8.43) min；术后首日疼痛评分分别为2.8±0.68和1.47±0.67,义眼片佩戴时间分别为(6.27±2.73)周和(3.07±2.11)周.以上指标两组间差异均有统计学意义(P＜0.01).结论与传统球后视神经离断组相比,视神经不离断的眼内容物剜除并Ⅰ期义眼台置入术具有术中损伤小、耗时短、术后疼痛轻、恢复快的优势.
목적 탐토시신경불리단적안내용물완제병Ⅰ기의안태치입술적림상료효.방법 대122례환자(122지안)수궤분성A、B량조,술중균선행상규안내용물완제술,자섭상지비하상한사행전개공막전층,부분공막각위량판,병방치HA의안태.량조술중처리시신경적방식불동:A조위전통구후시신경리단,B조위연시유두주위2 mm주원형공막전개.대술중지혈시간、구결막봉합장력、동통、의안태치입후검렬대소、수술시간；대술후동통、구결막수종화충혈、의안편패대시간행대비분석.결과 A、B량조술중압박지혈시간분별위(23.46±6.96) min화(5 49±1.72)min,구결막봉합장력평분분별위3.39±0.74화0.45±0.59,수술시간분별위(79.44±10.81) min화(43.46±8.43) min；술후수일동통평분분별위2.8±0.68화1.47±0.67,의안편패대시간분별위(6.27±2.73)주화(3.07±2.11)주.이상지표량조간차이균유통계학의의(P＜0.01).결론 여전통구후시신경리단조상비,시신경불리단적안내용물완제병Ⅰ기의안태치입술구유술중손상소、모시단、술후동통경、회복쾌적우세.
Objective To observe the clinical effects of a new method:non-optic nerve transecring evisceration combined with first stage hydroxyapatite orbital implantation.Methods One hundred and twenty two eyes (122 cases) were randomly divided into group A and group B,evisceration was first undertaken,the scleral wall was superior-temporally to inferior-nasally dissected and double scleral petals were placed before the implanted hydroxyapatite artificial eyeball.The difference between group A and group B was:in group A,the optic nerve was transected behind the eyeball,but in group B,a 2 mm outside the optic nerve scleral circle cutting was taken.Hemostasis time before implantation,tensile force during conjunctival suture,pain during surgery,palpebral fissure height after eye speculum wearing,operation time consuming,pain after surgery,conjunctival edema and congestion,and ocular prosthesis wearing time were compared between the two groups.Results In groups A and B,the intra-operative hemostasis time were (23.46 ± 6.96)mins and (5.49 ± 1.72)mins,the tensile force score during conjunctiva suture were 3.39±0.74 and 0.45±0.59,the score of pain in the first day were 2.8 ±0.68 and 1.47 ± 0.67,the ocular prosthesis wearing time after surgery were (6.27±2.73) and (3.07 ± 2.11)weeks,respectively.The differences of all the parameters above were with statistical significance between groups A and B (P＜0.01).During 2 years follow-up,no complications such as orbital implant exposure or infection happened.Conclusions Compared to traditional methods,the non-optic nerve transecting evisceration method has merits of less impairment,short time-consuming,less pain,and quicker postoperative recovery.