CAJ | 학술논문

目的探讨手术切除联合掺钕钇铝石榴石激光(Nd:YAG)凝固治疗眼眶静脉畸形的有效性和安全性.方法回顾性系列病例研究.采用手术切除联合激光凝固的方法治疗眼眶静脉畸形患者17例.全身麻醉,根据瘤体部位、大小、与眼外肌和毗邻神经的关系,选择适当的手术径路,充分暴露瘤体,手术切除和激光凝固交替进行.激光凝固方式包括小剂量短时光凝和连续光凝,前者能量密度设定为60～80 J/cm2,后者能量密度不超过90～100 J/cm2.体积小、病变深,周围有重要的神经或血管时采用小剂量短时光凝;体积大、易暴露,且距重要的组织较远时用连续光凝.光凝后立即用低温生理盐水冲洗光凝部位予以降温,防止损伤周围正常组织.结果术后随访12～26个月,17例患者中疗效显著15例(88.24%),有效2例(11.76%),总有效率100%.术后所有患者无视力下降(2例视力提高),眼球突出完全矫正,其中4例出现眼球内陷,眼球运动明显改善.并发症包括:上斜肌麻痹1例,上睑下垂1例.随访期内无一例复发或残存病变增大.结论手术联合Nd:YAG激光治疗眼眶静脉畸形是安全和有效的.激光凝固可减少术中出血,简便手术操作,降低手术风险,提高手术疗效.(中华眼科杂志,2008,44:681-686)
목적 탐토수술절제연합참녀을려석류석격광(Nd:YAG)응고치료안광정맥기형적유효성화안전성.방법 회고성계렬병례연구.채용수술절제연합격광응고적방법치료안광정맥기형환자17례.전신마취,근거류체부위、대소、여안외기화비린신경적관계,선택괄당적수술경로,충분폭로류체,수술절제화격광응고교체진행.격광응고방식포괄소제량단시광응화련속광응,전자능량밀도설정위60～80 J/cm2,후자능량밀도불초과90～100 J/cm2.체적소、병변심,주위유중요적신경혹혈관시채용소제량단시광응;체적대、역폭로,차거중요적조직교원시용련속광응.광응후립즉용저온생리염수충세광응부위여이강온,방지손상주위정상조직.결과 술후수방12～26개월,17례환자중료효현저15례(88.24%),유효2례(11.76%),총유효솔100%.술후소유환자무시력하강(2례시력제고),안구돌출완전교정,기중4례출현안구내함,안구운동명현개선.병발증포괄:상사기마비1례,상검하수1례.수방기내무일례복발혹잔존병변증대.결론 수술연합Nd:YAG격광치료안광정맥기형시안전화유효적.격광응고가감소술중출혈,간편수술조작,강저수술풍험,제고수술료효.(중화안과잡지,2008,44:681-686)
Objective To evaluate the security and efficacy of surgical procedure combined with Nd:YAG laser in the management of orbital venous malformation. Methods A total of 17 successive patients with orbital venous malformation were treated with surgical excision in conjunction with Nd:YAG laser from July 2003 to June 2005. General anesthesia was performed in all patients. Appropriate approach was used according to the location and size of the lesion as well as its relation with adjacent tissues. Surgical procedure and laser coagulation were performed alternatively. Intermittent or continuous photocoagulation aimed at minor and deep lesions or large and superficial lesions was administrated, respectively, when indicated. Laser power of these two procedures was set at 60 to 90 J/cm2 or less than 100 J/cm2,respectively. Cold saline solution was used to cool the targeted region immediately after photocoagulation in case of damage to surrounding normal tissues. Results Seventeen patients were followed-up for 12 to 26 months. Notable lesion regression was found in 15 cases and fair reduction of the lesion in 2 cases. Vision acuity decrease did not occur and vision acuity increase was found in 2 patients. Exophthalmos was completely corrected, enophthalmos was found in 4 patients, the movement of the eyeballs was markedly improved. Complications consisted of superior oblique muscle paralysis (1 case) and ptosis (1 case).Relapse or aggravation of residual lesion was not found during the whole follow-up period. Conclusions Surgical procedure combined with Nd:YAG laser is a safe and effective procedure in managing patients with orbital venous malformation. Laser treatment can decrease the hemorrhage during operation, make the surgical procedure easier, reduce the risk of operation and improve the results of surgical treatment. (Chin J Ophthalmol,2008,44:681-686)