CAJ | 학술논문

目的观察23G微创玻璃体手术相关并发症,分析其影响因素.方法行23G玻璃体切割手术治疗的150例纳入研究.其中,黄斑疾病98例,占65.3％；增生型糖尿病视网膜病变46例,占30.7％；其他原因玻璃体积血4例,占2.7％；孔源性视网膜脱离1例,占0.7％；白内障手术中晶状体核脱落1例,占0.7％.黄斑疾病患者中眼表面麻醉21例,占21.4％,球后阻滞麻醉77例,占78.6％.应用DORC系统两步法3例,Alcon 23G微创玻璃体切割手术套管穿刺一步法147例.手术中操作包括曲安奈德辅助下玻璃体后脱离、清除玻璃体后皮质,剥除视网膜前膜、内界膜,眼内激光光凝、气液交换,联合晶状体超声乳化人工晶状体植入等.手术时间20～100 min,平均手术时间(51.1±18.9) min.手术后随访3～12个月.观察手术中和手术后并发症发生情况.结果 150例中,手术中发生并发症7例,占4.7％.其中,器械断裂致医源性裂孔 1例,占0.7％；患者头部活动致黄斑损伤1例,占0.7％；灌注套管松脱致脉络膜上腔灌注1例,占0.7％；穿刺口渗漏、切口缝合2例,占1.3％；穿刺口出血进入玻璃体腔1例,占0.7％；发生塞子断裂于套管内1例,占0.7％.手术后发生并发症34例,占22.7％.其中,视网膜脱离1例,占0.7％,再次手术复位；玻璃体积血再次手术3例,占2.0％；行二期白内障手术3例,占2.0％；眼压＜10 mm Hg(1 mm Hg=0.133 kPa)20例,占13.3％,未干预眼压恢复正常14例,行包扎制动等保守治疗,眼压恢复正常5例,缝合切口,眼压恢复1例；一过性高眼压7例,占4.7％,经降眼压药物治疗,眼压均恢复正常.末次随访时,未见与手术相关的眼内炎等并发症.结论手术中切口相关并发症和手术后一过性低眼压是23G微创手术的常见并发症.
목적 관찰23G미창파리체수술상관병발증,분석기영향인소.방법 행23G파리체절할수술치료적150례납입연구.기중,황반질병98례,점65.3％；증생형당뇨병시망막병변46례,점30.7％；기타원인파리체적혈4례,점2.7％；공원성시망막탈리1례,점0.7％；백내장수술중정상체핵탈락1례,점0.7％.황반질병환자중안표면마취21례,점21.4％,구후조체마취77례,점78.6％.응용DORC계통량보법3례,Alcon 23G미창파리체절할수술투관천자일보법147례.수술중조작포괄곡안내덕보조하파리체후탈리、청제파리체후피질,박제시망막전막、내계막,안내격광광응、기액교환,연합정상체초성유화인공정상체식입등.수술시간20～100 min,평균수술시간(51.1±18.9) min.수술후수방3～12개월.관찰수술중화수술후병발증발생정황.결과 150례중,수술중발생병발증7례,점4.7％.기중,기계단렬치의원성렬공 1례,점0.7％；환자두부활동치황반손상1례,점0.7％；관주투관송탈치맥락막상강관주1례,점0.7％；천자구삼루、절구봉합2례,점1.3％；천자구출혈진입파리체강1례,점0.7％；발생새자단렬우투관내1례,점0.7％.수술후발생병발증34례,점22.7％.기중,시망막탈리1례,점0.7％,재차수술복위；파리체적혈재차수술3례,점2.0％；행이기백내장수술3례,점2.0％；안압＜10 mm Hg(1 mm Hg=0.133 kPa)20례,점13.3％,미간예안압회복정상14례,행포찰제동등보수치료,안압회복정상5례,봉합절구,안압회복1례；일과성고안압7례,점4.7％,경강안압약물치료,안압균회복정상.말차수방시,미견여수술상관적안내염등병발증.결론 수술중절구상관병발증화수술후일과성저안압시23G미창수술적상견병발증.
Objective To observe the related complications of 23G pars plana vitrectomy (PPV).Methods One hundred and fifteen patients who underwent 23G PPV were enrolled in this study.There were 98 patients (65.3％) with macular diseases, 46 patients (30.7％) with proliferative diabetic retinopathy,four patients (2.7％) with vitreous hemorrhage,one patient (0.7％) with rhegmatogenous retinal detachment,and lens nucleus falling off in cataract surgery in one patient (0.7％).Among 98 patients with macular diseases,21 patients (21.4％) underwent topical anesthesia,77 patients (78.6％)underwent retrobulbar anesthesia.DORC "two-step method" was performed in three patients,and Alcon 23G PPV "one-step method" was performed in 147 patients.The operation times ranged from 20 to 100 minutes,with a mean of (51.1 ± 18.9) minutes.The follow-up ranged from three to 12 months.The intraoperative and postoperative complications were observed.Results Intraoperative complications was found in seven patients (4.7％),which included iatrogenic retinal breaks in one patient (0.7％),macular damage in one patient (0.7％),suprachoroidal perfusion in one patient (0.7％),puncture leakage and closure incision in two patients (1.3 ％ ),vitreous hemorrhage in one patient (0.7 ％ ) and stopper broken off in cannula in one patient (0.7％).Postoperative complications was found in 34 patients (22.7％),which including retinal detachment in one patient (0.7 ％),vitreous hemorrhage in three patients (2.0 ％ ),cataract in three patient (2.0％),intraocular pressure ＜ 10 mm Hg (1 mm Hg =0.133 kPa) in 20 patient (13.3％),and transient ocular hypertension in seven patients (4.7％). After treatment there was no complication associated with surgery. Conclusion Intraoperative complications related to incision and transient hypotony are mainly complications of 23G PPV.