CAJ | 학술논문

目的比较三通道23G切口硅油取出术和两通道20G切口硅油取出术的临床效果及手术并发症.方法临床病例对照研究.选择2012年1～12月在长沙爱尔眼科医院的网膜复位良好、行硅油取出术的病人分为两组:A组用三通道23G切口,颞下方套管放置灌注管,与玻璃体切割机相连的输液管从右上方穿刺口抽取硅油至硅油取净,并进行气-液交换两次;B组采用两通道20G切口,颞下方睫状体平坦部做灌注,无晶状体眼者采用右上方角膜隧道切口取硅油,有晶状体眼采用右上方睫状体平坦部切口取硅油.结果 A组与B组平均手术时间分别为(38.41±10.32) rain及(36.57±9.88) min,两组差异无统计学意义(t =1.089,P＞0.05).A组视力提高43只眼、不变20只眼、降低7只眼,B组提高40只眼、不变23只眼、降低9只眼.两组之间差异无统计学意义(x2=0.540,P＞0.05).A组与B组术后眼部不适感持续时间分别为(7.33±3.05)d及(17.68±3.51)d,两组差异有统计学意义(t =18.747,P=0.00,P＜0.05).术后硅油残留者,A组为0只眼,B组为6只眼,差异有统计学意义(z =-2.459,P＜0.05).A组中有1只眼发生脉络膜上腔出血,B组为0只眼差异无统计学意义(z =-1.014,P＞0.05).A组3只眼发生视网膜再脱离,B组为10只眼,差异无统计学意义(x2=3.936,P＜0.05).A、B两组术后高眼压分别为3只眼、8只眼(z=-1.516,P＞0.05),低眼压各为5只眼.A组角膜情况好转10只眼、不变55只眼、恶化5只眼,B组分别为9只眼、56只眼、7只眼(x2=0.367,P＞0.05).结论 23G三切口手术过程简便,可进行膜剥离,术后视网膜脱离复发率低、硅油残留少、患者感觉更舒适,并且不增加手术时间,具有一定的临床应用价值.
목적 비교삼통도23G절구규유취출술화량통도20G절구규유취출술적림상효과급수술병발증.방법 림상병례대조연구.선택2012년1～12월재장사애이안과의원적망막복위량호、행규유취출술적병인분위량조:A조용삼통도23G절구,섭하방투관방치관주관,여파리체절할궤상련적수액관종우상방천자구추취규유지규유취정,병진행기-액교환량차;B조채용량통도20G절구,섭하방첩상체평탄부주관주,무정상체안자채용우상방각막수도절구취규유,유정상체안채용우상방첩상체평탄부절구취규유.결과 A조여B조평균수술시간분별위(38.41±10.32) rain급(36.57±9.88) min,량조차이무통계학의의(t =1.089,P＞0.05).A조시력제고43지안、불변20지안、강저7지안,B조제고40지안、불변23지안、강저9지안.량조지간차이무통계학의의(x2=0.540,P＞0.05).A조여B조술후안부불괄감지속시간분별위(7.33±3.05)d급(17.68±3.51)d,량조차이유통계학의의(t =18.747,P=0.00,P＜0.05).술후규유잔류자,A조위0지안,B조위6지안,차이유통계학의의(z =-2.459,P＜0.05).A조중유1지안발생맥락막상강출혈,B조위0지안차이무통계학의의(z =-1.014,P＞0.05).A조3지안발생시망막재탈리,B조위10지안,차이무통계학의의(x2=3.936,P＜0.05).A、B량조술후고안압분별위3지안、8지안(z=-1.516,P＞0.05),저안압각위5지안.A조각막정황호전10지안、불변55지안、악화5지안,B조분별위9지안、56지안、7지안(x2=0.367,P＞0.05).결론 23G삼절구수술과정간편,가진행막박리,술후시망막탈리복발솔저、규유잔류소、환자감각경서괄,병차불증가수술시간,구유일정적림상응용개치.
Objective To compare the clinical effects and surgical complications of silicone oil removal via the three-channel 23-gauge(23G)incision with the two-channel 20-gauge(20G)incision.Methods Patients who underwent silicone oil removal from January 2012 to December 2012 were included in this study.They were randomly divided into two groups.In group A,three-channel 23G incisions was used.The perfusion tube was placed in the inferior temporal eyeball,and the vitrectomy machine was connected to the superior incision by the infusion tube.The silicone oil was removed via this superior incision and for gas-liquid exchange twice hereafter.As for group B,two-channel 20G incisions were adopted.An inferior temporal pars plana irrigation was placed,silicone oil was extracted from the superior corneal tunnel incision in aphakic eyes,and from pars plana incision in phakic eye.Results The average operative time was 38.41±10.32min and 36.57±9.88min in group A and group B respectively,no statistically significant difference(t =1.089,P ＞0.05).In group A,the visual acuity was improved in 43 eyes,unchanged in 20 eyes,decreased in 7 eyes.In group B,the visual acuity was improved in 40 eyes,unchanged in 23 eyes,decreased in 9 eyes.No significant difference between the two groups(x2=0.540,P ＞0.05).The duration of postoperative discomfort in group A and group B was 7.33±3.05 days and 17.68±3.51 days respectively.The difference was statistically significant(t =18.747,P =0.00).The postoperative silicone oil residue occurred in 0 case in group A,and 6 cases in group B (z =-2.459,P ＜0.05).SuprachoroidaI hemorrhage occurred in one eye in group A,and 0 in group B(z =-1.014,P ＞0.05).Retinal redetachment emerged in 3 eyes in group A,and 10 eyes in group B(x2=3.936,P ＜0.05).Higher intraocular pressure in group A and group B was 3 eyes and 8 eyes respectively(z =-1.516,P ＞0.05),lower intraocular pressure in each group was 5 eyes.Cornea condition was improved in 10 eyes,unchanged in 55 eyes,worsen in 5 eyes in group A; as in group B the number was 9,56 and 7(x2=0.367,P ＞0.05).Conclusions The procedure with the three-channel 23G incision is simple and the membrane can be peeled.The 23G procedure has lower rate of retinal redetachment,fewer silicone oil residue,more comfortable postoperative feeling,and the same operative time.In conclusion,silicone oil removal via 23G has certain clinical application value.