CAJ | 학술논문

目的探讨先天性小眼球患者眼眶发育期及发育期后的整复方法和疗效.方法回顾性系列病例研究.自2008年1月至2010年7月,对＜12岁的18例先天小眼球患儿行自膨胀水凝胶眶内植入术,其中11例患者行球体自膨胀水凝胶眼球后充填术,5例行半球体自膨胀水凝胶植入结膜囊扩张术,2例行圆柱体自膨胀水凝胶眼眶内充填术.而对≥12岁的28例小眼球患者针对其存在的畸形采取相应的整复治疗,14例单纯行外眦开大术,12例行内外眦联合开大术,3例在内眦或外眦开大术后再次行上睑下垂矫正术,2例行结膜囊成形术.两组间比较采用t检验.结果所有病例伤口愈合良好,除1例水凝胶球体眶内植入患者植入物移位,经调整,未再偏位.1例结膜囊扩张术后2周植入物提前自结膜囊脱出,但结膜囊狭窄仍有较大改善,其余16例患者植入物无移位,无脱出.发育期患者术后睑裂长度为(18.67±1.74)mm,较术前(15.83±1.87)mm明显开大,差异有统计学意义(t=-4.029,P=0.01);而睑裂高度术前为(1.33±0.67)mm,术后为(6.00±0.58)mm,差异有统计学意义(t=-5.813,P=0.00).发育期后患者经过眼睑及眼窝整复后,睑裂明显开大,外观有极大改善.结论先天小眼球患者应针对其发育的不同时期进行整复治疗,可达到较好的美容效果.
목적 탐토선천성소안구환자안광발육기급발육기후적정복방법화료효.방법 회고성계렬병례연구.자2008년1월지2010년7월,대＜12세적18례선천소안구환인행자팽창수응효광내식입술,기중11례환자행구체자팽창수응효안구후충전술,5례행반구체자팽창수응효식입결막낭확장술,2례행원주체자팽창수응효안광내충전술.이대≥12세적28례소안구환자침대기존재적기형채취상응적정복치료,14례단순행외자개대술,12례행내외자연합개대술,3례재내자혹외자개대술후재차행상검하수교정술,2례행결막낭성형술.량조간비교채용t검험.결과 소유병례상구유합량호,제1례수응효구체광내식입환자식입물이위,경조정,미재편위.1례결막낭확장술후2주식입물제전자결막낭탈출,단결막낭협착잉유교대개선,기여16례환자식입물무이위,무탈출.발육기환자술후검렬장도위(18.67±1.74)mm,교술전(15.83±1.87)mm명현개대,차이유통계학의의(t=-4.029,P=0.01);이검렬고도술전위(1.33±0.67)mm,술후위(6.00±0.58)mm,차이유통계학의의(t=-5.813,P=0.00).발육기후환자경과안검급안와정복후,검렬명현개대,외관유겁대개선.결론 선천소안구환자응침대기발육적불동시기진행정복치료,가체도교호적미용효과.
Objective To investigate the therapeutic procedures and their efficiencies for the treatment of congenital microphthalmos during or after the developing period. Methods It was a retrospective case series study. Eighteen cases with congenital microphthalmos,aged less than 12 years,underwent self inflating osmotic hydrogel expanders. Among them,11 cases were treated by implantation with sphere self-inflating hydrogel expanders into the retrobulbar space and 5 cases had implantations into the conjunctival socket The remaining 2 cases were treated with implantation of injectable self-inflating hydrogel pellet expanders. Twenty eight cases with congenital microphthalmos,aged more than 12 years,accompanied with other deformities,were treated with proper reconstruction surgery. Fourteen cases were treated with medial canthoplasty,12 caseswere treated with medial and lateral canthoplasty,3 cases were treated with ptosis correction and medial or lateral canthoplasty and 2 cases with socket reconstruction. T-test was used for the comparision between groups. Results Sixteen cases obtained satisfactory results without any complications. In one case,the hydrogel expanders migrated inferiorly in the orbit and underwent adjustment In another case,although the hydrogel expander prolapsed from the socket,the socket was still expanded. In the developing period,the length of palpebral fissure was ( 15.83 ± 1.87 ) mm before the operation,and that made much wider after the operation (18. 67 ± 1.74) mm. There were statistically significant differences between them ( t = -4. 029,P = 0. 01 ). The height of palpebral fissure was ( 1.33 ±0. 67) mm and (6. 00 ± 0. 58 ) mm before and after the operation,respectively,which were statisfcally significant (t = -5. 813,P =0. 00). Patients who aged more than 12 years and underwent eyelids and eye socket reconstruction,also obtained satisfactory appearance. Conclusion Patients with congenital microphthalmos could obtain the development of orbit and satisfactory appearance by reconstruction treatment according to different period of development.