中国实用眼科杂志
中國實用眼科雜誌
중국실용안과잡지
CHINESE JOURNAL OF PRACTICAL OPHTHALMOLOGY
2013年
2期
194-197
,共4页
玻璃体手术%视网膜脱离%巩膜穿刺内口%危险因素
玻璃體手術%視網膜脫離%鞏膜穿刺內口%危險因素
파리체수술%시망막탈리%공막천자내구%위험인소
Vitrectomy surgery%Retina detachment%Inner sclerotomy sites%Risk factors
目的 探讨玻璃体手术中探查及处理巩膜穿刺孔内口的必要性及手术效果.方法 分析2009年1月至2011年12月行标准20G玻璃体切割手术113只眼作为研究对象,其中53只眼为观察组,手术结束时检查巩膜穿刺孔内口情况,根据术中探查,将巩膜穿刺孔内口玻璃体嵌顿分为5级,以Ⅱ级以上玻璃体嵌顿为有临床意义,发现异常进行相应处理和常规巩膜外冷冻.60只眼为对照组,对照组复发性视网膜脱离再手术患者术中亦进行巩膜穿刺口探查和处理.结果 观察组1次手术成功48例(90.5％)；对照组45例(75％),15例再次手术,观察组手术成功率明显高于对照组(x2=4.68,P＜0.05),对比有统计学意义.观察组巩膜穿刺孔并发症发生率45％,而对照再手术为70％.玻璃体嵌顿主要发生在上方的巩膜切口,颞下方少.观察组发生周边医源性视网膜裂孔7.5％,而对照再手术组为67％.全部裂孔位于上方两个巩膜穿刺孔内口所在的象限,且10点位多于2点位.结论 玻璃体手术中,巩膜穿刺孔玻璃体嵌顿并发症十分常见,是玻璃体手术失败的主要原因.应重视手术中巩膜穿刺孔内口的探查,预防和处理巩膜穿刺孔玻璃体嵌顿引起的并发症可明显提高手术的成功率.
目的 探討玻璃體手術中探查及處理鞏膜穿刺孔內口的必要性及手術效果.方法 分析2009年1月至2011年12月行標準20G玻璃體切割手術113隻眼作為研究對象,其中53隻眼為觀察組,手術結束時檢查鞏膜穿刺孔內口情況,根據術中探查,將鞏膜穿刺孔內口玻璃體嵌頓分為5級,以Ⅱ級以上玻璃體嵌頓為有臨床意義,髮現異常進行相應處理和常規鞏膜外冷凍.60隻眼為對照組,對照組複髮性視網膜脫離再手術患者術中亦進行鞏膜穿刺口探查和處理.結果 觀察組1次手術成功48例(90.5％)；對照組45例(75％),15例再次手術,觀察組手術成功率明顯高于對照組(x2=4.68,P＜0.05),對比有統計學意義.觀察組鞏膜穿刺孔併髮癥髮生率45％,而對照再手術為70％.玻璃體嵌頓主要髮生在上方的鞏膜切口,顳下方少.觀察組髮生週邊醫源性視網膜裂孔7.5％,而對照再手術組為67％.全部裂孔位于上方兩箇鞏膜穿刺孔內口所在的象限,且10點位多于2點位.結論 玻璃體手術中,鞏膜穿刺孔玻璃體嵌頓併髮癥十分常見,是玻璃體手術失敗的主要原因.應重視手術中鞏膜穿刺孔內口的探查,預防和處理鞏膜穿刺孔玻璃體嵌頓引起的併髮癥可明顯提高手術的成功率.
목적 탐토파리체수술중탐사급처리공막천자공내구적필요성급수술효과.방법 분석2009년1월지2011년12월행표준20G파리체절할수술113지안작위연구대상,기중53지안위관찰조,수술결속시검사공막천자공내구정황,근거술중탐사,장공막천자공내구파리체감돈분위5급,이Ⅱ급이상파리체감돈위유림상의의,발현이상진행상응처리화상규공막외냉동.60지안위대조조,대조조복발성시망막탈리재수술환자술중역진행공막천자구탐사화처리.결과 관찰조1차수술성공48례(90.5％)；대조조45례(75％),15례재차수술,관찰조수술성공솔명현고우대조조(x2=4.68,P＜0.05),대비유통계학의의.관찰조공막천자공병발증발생솔45％,이대조재수술위70％.파리체감돈주요발생재상방적공막절구,섭하방소.관찰조발생주변의원성시망막렬공7.5％,이대조재수술조위67％.전부렬공위우상방량개공막천자공내구소재적상한,차10점위다우2점위.결론 파리체수술중,공막천자공파리체감돈병발증십분상견,시파리체수술실패적주요원인.응중시수술중공막천자공내구적탐사,예방화처리공막천자공파리체감돈인기적병발증가명현제고수술적성공솔.
Objective To investigate the importance and outcome of exploring and treating inner aspects of sclerotomies during vitreous surgery.Methods Record of patients' undergone 20G pars plana vitrectomy (PPV) between January 2009 and December 2011 were enrolled.Data was available for 113 eyes,which classified to observation group (53 eyes) and control group (60 eyes).Intraopertive observation at the end of the surgery,Based on the intraoperative observation,the vitreous incarceration at inner aspects of Sclerotomies (IAS) was classified into five grades.More than Grade Ⅱ had clinical significance,once found abnormal treated immediately and frozen commonly around the inner aspects of sclerotomies.The eyes at control group had retina redetachment were explored and treated the inner aspects of sclerotomies during reoperation as well.Results Forty-eight eyes at observation group (90.5％) and 45 eyes at control group (75％) achieved anatomical retina reattachment with one vitreous surgery.Compared to the control group,the observation group in the eyes with anatomical success was significantly improved (x2=4.68,P ＜0.05).The sclerotomy-related complications at observation group were 45％,and the rate of needing second surgery was 70％.The vitreous incarceration occurred mainly at superior sclerotomy site,less at bitamporal below site.The rate of sclerotomy-related retinal breaks at observation group was 7.5％,and need to second surgery was 67％.All sclerotomy-related retinal breaks occurred at the quadrants with superior sclerotomy sites,and breaks found at 10 o'clock site were more than 2 o'clock site.Conclusions The vitreous incarceration at inner aspects of sclerotomies is very common clinical complications during pars plana vitrectomy,which has the chief cause of vitreous surgery failure.More attentions shall be paid to intraoperative observation and treatment of inner aspects of sclerotomies during vitrectomy surgery,which can prevent the complications from the vitreous incarceration,and improve the successful rate of operation.
