CAJ | 학술논문

目的通过分析经玻璃体切除联合硅油填充治疗的复杂视网膜脱离病例的临床特征,探讨影响其复发的危险因素和机制.方法临床病例系列研究.回顾分析2008年1月至2013年12月在绵阳市中心医院因复杂视网膜脱离行玻璃体切除联合硅油填充术病例578例(578只眼),对其各种临床特征进行分层分析,计算相对危险度,找到影响视网膜脱离复发的危险因素.结果术前玻璃体视网膜增殖(PVR)D级、高度近视、下方裂孔及黄斑裂孔合并高度近视是复发的重要危险因素,其OR值和95％CI分别为:4.126 (2.481,6.862),1.841 (1.125,3.011),11.141 (5.094,24.359),7.181(2.794,18.454).而术前裂孔大小、裂孔数量、中低度近视、手术者的差异等对术后是否复发无明显影响(P＞0.05).总复发病例75例中裂孔未愈合或出现新裂孔的占82.67％(62/75),既有裂孔又存在PVR C级以上的为42.67％ (32/75),完全未见裂孔只存在PVR的占17.33％ (13/75).结论首次手术选择玻璃体切除联合硅油填充的病例中若合并下方裂孔、PVR分级D级、高度近视、高度近视合并黄斑裂孔这四种因素之一,术后复发几率将增加.在复发过程中,裂孔未及时愈合或新裂孔的发生是复发的主要机制.
목적 통과분석경파리체절제연합규유전충치료적복잡시망막탈리병례적림상특정,탐토영향기복발적위험인소화궤제.방법 림상병례계렬연구.회고분석2008년1월지2013년12월재면양시중심의원인복잡시망막탈리행파리체절제연합규유전충술병례578례(578지안),대기각충림상특정진행분층분석,계산상대위험도,조도영향시망막탈리복발적위험인소.결과 술전파리체시망막증식(PVR)D급、고도근시、하방렬공급황반렬공합병고도근시시복발적중요위험인소,기OR치화95％CI분별위:4.126 (2.481,6.862),1.841 (1.125,3.011),11.141 (5.094,24.359),7.181(2.794,18.454).이술전렬공대소、렬공수량、중저도근시、수술자적차이등대술후시부복발무명현영향(P＞0.05).총복발병례75례중렬공미유합혹출현신렬공적점82.67％(62/75),기유렬공우존재PVR C급이상적위42.67％ (32/75),완전미견렬공지존재PVR적점17.33％ (13/75).결론 수차수술선택파리체절제연합규유전충적병례중약합병하방렬공、PVR분급D급、고도근시、고도근시합병황반렬공저사충인소지일,술후복발궤솔장증가.재복발과정중,렬공미급시유합혹신렬공적발생시복발적주요궤제.
Objective To find out risk factors of recurrence retinal detachment (RD) with silicone oil (SO) tamponade by analyze their clinical feature.Methods A retrospective study of 578 patients (578 eyes) who underwent vitrectomy and SO tamponade for complex retinal detachment between January 2008 and December 2013.Their clinical feature was analyzed in stratification,odds ratio was calculated and risk factors were found.Results PVRD,high myopia,inferior retina holes and macular holes combined high myopia were the main risk factor for recurrence RD with SO tamponade.Their OR and 95％CI were 4.126(2.481,6.862),1.841(1.125,3.011),11.141(5.094,24.359),7.181(2.794,18.454) respectively.The size and quantity of breaks,moderate myopia and different surgeon had no effect on recurrence of RD (P ＞0.05).Recurrent patients,who with unclosed breaks or new breaks was 82.67％ of total recurrence (75 patients),who with more than PVRC and unclosed breaks was 42.67％,and who with only PVR without breaks was 17.33％.Conclusions Recurrent ratio of patients who underwent vitrectomy and SO tamponade in the first time will increase if one of the following factors is involved,including PVRD,high myopia,inferior retina holes and macular hole combined high myopia.Unclose breaks or new breaks may play a key role in the recurrence of RD.