目的 探讨结膜松弛定位与定量片在结膜松弛切除术中的作用.方法 病例对照研究.2007年1月至2008年11月收集30例双眼Ⅲ级结膜松弛症患者门诊手术,按患者手术的先后顺序,双眼交替行单纯结膜切除术、结膜松弛定位与定量片下的结膜切除术(即片下结膜切除术).按上述不同的手术方法分两组,术后1、3、6个月分别进行主、客观疗效评价.主观疗效以有效率、治愈率为评价指标;客观疗效以裂隙灯显微镜形态学变化、泪河测量、泪膜破裂时间(BUT)、基础泪液分泌试验(SIT)、眼表荧光素染色(Fl)、第一荧光素染色试验为评价指标.率的比较采用χ2检验.结果 主观疗效评价术后1个月,单纯结膜切除术治愈5只眼(16.7%),改善13只眼(43.3%),无效12只眼(40.0%);片下结膜切除术治愈12只眼(40.0%),改善16只眼(53.3%),无效2只眼(6.7%).两组间有效率(χ2=9.317,P＜0.01)、治愈率(χ2=4.022,P＜0.05),差异均有统计学意义;术后3、6个月单纯结膜切除术有效率逐步增加,片下的结膜切除术有效率稳定,治愈率仍高于单纯结膜切除术.客观疗效评价术后1个月,两组间裂隙灯显微镜下观察形态学变化,单纯结膜切除术组正常10只眼,片下结膜切除术组正常29只眼(χ2=26.447,P＜0.01);泪河测量,单纯结膜切除术组正常18只眼,片下结膜切除术组正常30只眼(χ2=15.000,P＜0.01);BUT,单纯结膜切除术组正常12只眼,片下结膜切除术组正常28只眼(χ2=19.200,P＜0.01);S I T,单纯结膜切除术组正常18只眼,片下结膜切除术组正常25只眼(χ2=4.022,P＜0.05);Fl,单纯结膜切除术组正常20只眼,片下结膜切除术组正常28只眼(χ2=6.667,P＜0.05);第一荧光素染色试验,单纯结膜切除术组正常12只眼,片下结膜切除术组正常24只眼(χ2=10.000,P＜0.01);差异均有统计学意义.术后3个月时,S I T检测,单纯结膜切除术组正常18只眼,片下结膜切除术组正常19只眼(χ2=0.071,P＞0.05),差异无统计学意义;其余各指标比较差异均有统计学意义.术后6个月时,S I T检测,单纯结膜切除术组正常20只眼,片下结膜切除术组正常21只眼(χ2=0.077,P＞0.05);Fl,单纯结膜切除术组正常23只眼,片下结膜切除术组正常28只眼(χ2=3.268,P＞0.05),差异均无统计学意义;其余各指标比较差异均有统计学意义.结论 片下结膜切除术使切除松弛结膜定位、定量的操作安全、简便,并发症较少.
目的 探討結膜鬆弛定位與定量片在結膜鬆弛切除術中的作用.方法 病例對照研究.2007年1月至2008年11月收集30例雙眼Ⅲ級結膜鬆弛癥患者門診手術,按患者手術的先後順序,雙眼交替行單純結膜切除術、結膜鬆弛定位與定量片下的結膜切除術(即片下結膜切除術).按上述不同的手術方法分兩組,術後1、3、6箇月分彆進行主、客觀療效評價.主觀療效以有效率、治愈率為評價指標;客觀療效以裂隙燈顯微鏡形態學變化、淚河測量、淚膜破裂時間(BUT)、基礎淚液分泌試驗(SIT)、眼錶熒光素染色(Fl)、第一熒光素染色試驗為評價指標.率的比較採用χ2檢驗.結果 主觀療效評價術後1箇月,單純結膜切除術治愈5隻眼(16.7%),改善13隻眼(43.3%),無效12隻眼(40.0%);片下結膜切除術治愈12隻眼(40.0%),改善16隻眼(53.3%),無效2隻眼(6.7%).兩組間有效率(χ2=9.317,P＜0.01)、治愈率(χ2=4.022,P＜0.05),差異均有統計學意義;術後3、6箇月單純結膜切除術有效率逐步增加,片下的結膜切除術有效率穩定,治愈率仍高于單純結膜切除術.客觀療效評價術後1箇月,兩組間裂隙燈顯微鏡下觀察形態學變化,單純結膜切除術組正常10隻眼,片下結膜切除術組正常29隻眼(χ2=26.447,P＜0.01);淚河測量,單純結膜切除術組正常18隻眼,片下結膜切除術組正常30隻眼(χ2=15.000,P＜0.01);BUT,單純結膜切除術組正常12隻眼,片下結膜切除術組正常28隻眼(χ2=19.200,P＜0.01);S I T,單純結膜切除術組正常18隻眼,片下結膜切除術組正常25隻眼(χ2=4.022,P＜0.05);Fl,單純結膜切除術組正常20隻眼,片下結膜切除術組正常28隻眼(χ2=6.667,P＜0.05);第一熒光素染色試驗,單純結膜切除術組正常12隻眼,片下結膜切除術組正常24隻眼(χ2=10.000,P＜0.01);差異均有統計學意義.術後3箇月時,S I T檢測,單純結膜切除術組正常18隻眼,片下結膜切除術組正常19隻眼(χ2=0.071,P＞0.05),差異無統計學意義;其餘各指標比較差異均有統計學意義.術後6箇月時,S I T檢測,單純結膜切除術組正常20隻眼,片下結膜切除術組正常21隻眼(χ2=0.077,P＞0.05);Fl,單純結膜切除術組正常23隻眼,片下結膜切除術組正常28隻眼(χ2=3.268,P＞0.05),差異均無統計學意義;其餘各指標比較差異均有統計學意義.結論 片下結膜切除術使切除鬆弛結膜定位、定量的操作安全、簡便,併髮癥較少.
목적 탐토결막송이정위여정량편재결막송이절제술중적작용.방법 병례대조연구.2007년1월지2008년11월수집30례쌍안Ⅲ급결막송이증환자문진수술,안환자수술적선후순서,쌍안교체행단순결막절제술、결막송이정위여정량편하적결막절제술(즉편하결막절제술).안상술불동적수술방법분량조,술후1、3、6개월분별진행주、객관료효평개.주관료효이유효솔、치유솔위평개지표;객관료효이렬극등현미경형태학변화、루하측량、루막파렬시간(BUT)、기출루액분비시험(SIT)、안표형광소염색(Fl)、제일형광소염색시험위평개지표.솔적비교채용χ2검험.결과 주관료효평개술후1개월,단순결막절제술치유5지안(16.7%),개선13지안(43.3%),무효12지안(40.0%);편하결막절제술치유12지안(40.0%),개선16지안(53.3%),무효2지안(6.7%).량조간유효솔(χ2=9.317,P＜0.01)、치유솔(χ2=4.022,P＜0.05),차이균유통계학의의;술후3、6개월단순결막절제술유효솔축보증가,편하적결막절제술유효솔은정,치유솔잉고우단순결막절제술.객관료효평개술후1개월,량조간렬극등현미경하관찰형태학변화,단순결막절제술조정상10지안,편하결막절제술조정상29지안(χ2=26.447,P＜0.01);루하측량,단순결막절제술조정상18지안,편하결막절제술조정상30지안(χ2=15.000,P＜0.01);BUT,단순결막절제술조정상12지안,편하결막절제술조정상28지안(χ2=19.200,P＜0.01);S I T,단순결막절제술조정상18지안,편하결막절제술조정상25지안(χ2=4.022,P＜0.05);Fl,단순결막절제술조정상20지안,편하결막절제술조정상28지안(χ2=6.667,P＜0.05);제일형광소염색시험,단순결막절제술조정상12지안,편하결막절제술조정상24지안(χ2=10.000,P＜0.01);차이균유통계학의의.술후3개월시,S I T검측,단순결막절제술조정상18지안,편하결막절제술조정상19지안(χ2=0.071,P＞0.05),차이무통계학의의;기여각지표비교차이균유통계학의의.술후6개월시,S I T검측,단순결막절제술조정상20지안,편하결막절제술조정상21지안(χ2=0.077,P＞0.05);Fl,단순결막절제술조정상23지안,편하결막절제술조정상28지안(χ2=3.268,P＞0.05),차이균무통계학의의;기여각지표비교차이균유통계학의의.결론 편하결막절제술사절제송이결막정위、정량적조작안전、간편,병발증교소.
Objective To investigate the efficacy for treating conjunctivochalasis with conjunctival positioning and quantified patch. Methods It was a case-control study. A case-control study of 30 patients from the First Hospital of Jiaxing from 2007 to 2008 with binocular conjunctivochalasis. Every patient was treated one eye with simple logadectomy while the other eye with positioning and quantified logadectomy randomly. Subjective and objective evaluations were taken on the 1st, 3rd and 6th months postoperation. Subjective evaluations include effective rate and cure rate. Objective evaluations include slit-lamp biomicroscope morphological variety,tear menisus height, break-up time(BUT) ,Schirmer Ⅰ test( S I T),fluorescein stain test( Fl), the first fluorescein stain. Cure rate and efficacy rate were compared in two groups with chi-square test. Results Subjective evaluations were on the 1st month post-operation. There were 5 eyes ( 16. 7% ) curing,13 eyes (43. 3% ) improved,12 eyes (40. 0% ) ineffective in simply logadectomy group; While there were 12 eyes (40. 0% ) curing, 16 eyes (53.3%) improved,2 eyes (6. 7% ) ineffective in the positioning and quantified logadectomy group. The effective rate( χ2 =9. 317, P ＜0. 01 )and cure rate (χ2 = 4. 022, P ＜ 0. 05 )had statistic significance. Effecative rate in simply logadectomy group was increasing gradually on the 3rd and 6th month post-operation while effecative rate in positioning and quantified logadectomy group was stable. But the effective rate in this group was still higher than the simple logadectomy group. To objectively evaluate the cure rate on the 1st month post-operation: slit-lamp biomicroscope morphological variety: there were 10 eyes turn to normal in simply logadectomy group while 29 eyes ( χ2 =26. 447, P ＜ 0. 01 ) in the positioning and quantified logadectomy group. Tear menisus height:there were 18 eyes turn to normal in simply logadectomy group while 30 eyes ( χ2 = 15. 000 ,P ＜0. 01 ) in the positioning and quantified logadectomy group. BUT: There were 12 eyes turn to normal in simply logadectomy group while 28 eyes ( χ2 = 19. 200, P ＜ 0. 01 ) in the positioning and quantified logadectomy group. S I T: there were 18 eyes turn to normal in simply logadectomy group while 25 eyes (χ2 =4. 022,P ＜ 0. 05) in the positioning and quantified logadectomy group. Fl: there were 20 eyes turn to normal in simply logadectomy group while 28 eyes ( χ2 = 6. 667, P ＜ 0. 05 ) in the positioning and quantified logadectomy group. The first fluorescein stain: there were 12 eyes turn to normal in simply logadectomy group while 24 eyes (χ2 = 10. 000, P ＜0. 01 ) in the positioning and quantified logadectomy group. The difference had statistic significance. On the 3rd month post-operation: S I T: there were 18 eyes turn to normal in simply logadectomy group while 19 eyes ( χ2 =0. 071 ,P ＞0. 05) in the positioning and quantified logadectomy group, without statistic significance. All the other objective evaluations indicatrix had statistic significance. On the 6th month post-operation: S I T: there were 20 eyes turn to normal in simply logadectomy group while 21 eyes ( χ2 = 0. 077, P ＞ 0. 05 ) in the positioning and quantified logadectomy group, without statistic significance. Fl: there were 23 eyes turn to normal in simply logadectomy group while 28 eyes (χ2 = 3. 268 ,P ＞ 0. 05 ) in the positioning and quantified logadectomy group, without statistic significance. All the other objective evaluations indicatrix had statistic significance. Conclusions Positioning and quantified patch resection method not only makes it easier and safer for treating the conjunctivochalasis, but also reduces the complications and creates good result for patients in early periord.
