中华眼科杂志
中華眼科雜誌
중화안과잡지
Chinese Journal of Ophthalmology
2013年
3期
242-249
,共8页
王毅%肖利华%杨忠昆%李月月
王毅%肖利華%楊忠昆%李月月
왕의%초리화%양충곤%리월월
Graves眼病%减压术,外科%眼外科手术%治疗结果
Graves眼病%減壓術,外科%眼外科手術%治療結果
Graves안병%감압술,외과%안외과수술%치료결과
Graves ophthalmopathy%Decompression,surgical%Ophthalmologic surgical procedures%Treatment outcome
目的 评价改良眼眶减压术治疗重度甲状腺相关眼病(TAO)的手术效果和安全性.方法 回顾性系列病例研究.选择2009年1月至2011年1月在武警总医院眼眶病研究所诊治的40例(66只眼)重度TAO患者的手术资料,分为压迫性视神经病变(CON)组(30只眼)、眼球高度突出(MP)组(30只眼)和暴露性角膜病变(EK)组(6只眼).采用眉弓外侧“S”形切口或上睑重睑皱褶切口,联合泪阜结膜切口,行眼眶深外侧壁、内壁和下壁切除的眼眶减压术.记录术前和术后6个月的视力、眼球突出度、复视、临床活动性评分(CAS)及眼眶CT扫描等其他检查结果,记录术中和术后并发症.对计量资料采用配对t检验、等级资料采用Mann-Whitney U检验或Fisher确切概率法进行统计学分析.结果 CON组17只眼(56.7％)术后视力较术前提高(U=319.5,P＜0.05).术后CON组和MP组眼球回退值分别为(8.1±2.7)mm和(11.4±3.1)mm,与术前相比差异有统计学意义(t=11.73,P＜0.01；t=15.52,P＜0.01).术后CON组CAS评分显著下降(P＜0.01).CON组和MP组手术前、后复视程度无显著变化(U=131.0,P=0.309;U=157.5,P=0.881),CON组7例(39％)复视改善,3例(17％)新发或复视加重,MP组5例(28％)复视改善,4例(22％)新发或复视加重.手术还可改善色觉,降低眼压并使EK愈合.重要并发症有术中脑脊液漏、新发复视及眼球下移位等.结论 该术式切口隐蔽美观,暴露眼眶深外侧壁、内壁和下壁充分,减压效果确切,有助于视力恢复和眼球回退,缓解炎症活动,对复视无明显影响,并发症少,是治疗重度TAO安全而有效的手术方式.
目的 評價改良眼眶減壓術治療重度甲狀腺相關眼病(TAO)的手術效果和安全性.方法 迴顧性繫列病例研究.選擇2009年1月至2011年1月在武警總醫院眼眶病研究所診治的40例(66隻眼)重度TAO患者的手術資料,分為壓迫性視神經病變(CON)組(30隻眼)、眼毬高度突齣(MP)組(30隻眼)和暴露性角膜病變(EK)組(6隻眼).採用眉弓外側“S”形切口或上瞼重瞼皺褶切口,聯閤淚阜結膜切口,行眼眶深外側壁、內壁和下壁切除的眼眶減壓術.記錄術前和術後6箇月的視力、眼毬突齣度、複視、臨床活動性評分(CAS)及眼眶CT掃描等其他檢查結果,記錄術中和術後併髮癥.對計量資料採用配對t檢驗、等級資料採用Mann-Whitney U檢驗或Fisher確切概率法進行統計學分析.結果 CON組17隻眼(56.7％)術後視力較術前提高(U=319.5,P＜0.05).術後CON組和MP組眼毬迴退值分彆為(8.1±2.7)mm和(11.4±3.1)mm,與術前相比差異有統計學意義(t=11.73,P＜0.01；t=15.52,P＜0.01).術後CON組CAS評分顯著下降(P＜0.01).CON組和MP組手術前、後複視程度無顯著變化(U=131.0,P=0.309;U=157.5,P=0.881),CON組7例(39％)複視改善,3例(17％)新髮或複視加重,MP組5例(28％)複視改善,4例(22％)新髮或複視加重.手術還可改善色覺,降低眼壓併使EK愈閤.重要併髮癥有術中腦脊液漏、新髮複視及眼毬下移位等.結論 該術式切口隱蔽美觀,暴露眼眶深外側壁、內壁和下壁充分,減壓效果確切,有助于視力恢複和眼毬迴退,緩解炎癥活動,對複視無明顯影響,併髮癥少,是治療重度TAO安全而有效的手術方式.
목적 평개개량안광감압술치료중도갑상선상관안병(TAO)적수술효과화안전성.방법 회고성계렬병례연구.선택2009년1월지2011년1월재무경총의원안광병연구소진치적40례(66지안)중도TAO환자적수술자료,분위압박성시신경병변(CON)조(30지안)、안구고도돌출(MP)조(30지안)화폭로성각막병변(EK)조(6지안).채용미궁외측“S”형절구혹상검중검추습절구,연합루부결막절구,행안광심외측벽、내벽화하벽절제적안광감압술.기록술전화술후6개월적시력、안구돌출도、복시、림상활동성평분(CAS)급안광CT소묘등기타검사결과,기록술중화술후병발증.대계량자료채용배대t검험、등급자료채용Mann-Whitney U검험혹Fisher학절개솔법진행통계학분석.결과 CON조17지안(56.7％)술후시력교술전제고(U=319.5,P＜0.05).술후CON조화MP조안구회퇴치분별위(8.1±2.7)mm화(11.4±3.1)mm,여술전상비차이유통계학의의(t=11.73,P＜0.01；t=15.52,P＜0.01).술후CON조CAS평분현저하강(P＜0.01).CON조화MP조수술전、후복시정도무현저변화(U=131.0,P=0.309;U=157.5,P=0.881),CON조7례(39％)복시개선,3례(17％)신발혹복시가중,MP조5례(28％)복시개선,4례(22％)신발혹복시가중.수술환가개선색각,강저안압병사EK유합.중요병발증유술중뇌척액루、신발복시급안구하이위등.결론 해술식절구은폐미관,폭로안광심외측벽、내벽화하벽충분,감압효과학절,유조우시력회복화안구회퇴,완해염증활동,대복시무명현영향,병발증소,시치료중도TAO안전이유효적수술방식.
Objective To present a new technique for orbital decompression that minimizes surgical approaches while maximizing the removed areas of orbital walls and to evaluate the efficacy and safety of it for patients with severe thyroid associated ophthalmopathy (TAO).Methods A retrospective review of 40 cases (66 eyes) with severe TAO undergoing the modified decompression between January 2009 and January 2011 was conducted.All patients were assigned to three groups,which were group CON:compressive optic neuropathy in 30 eyes,group MP:marked proptosis in 30 eyes,and group EK:exposure keratopathy in 6 eyes.The deep lateral,medial walls and orbital floor decompressions were underwent via an eyelid crease or a lateral sub-brow S-shape approach with a transcaruncular approach.Clinical outcomes were recorded including visual acuity,exophthalmometry,diplopia,clinical activity score (CAS) and CT scans before and 6 months after surgery.Intra-and postoperative complications were recorded.Results The postoperative visual acuity was improved in 17 eyes (56.7％,P ＜ 0.05) of group CON.The mean proptosis reduction was (8.1 ±2.7)mm(t =11.73,P＜0.01) and (11.4±3.1)mm(t =15.52,P ＜0.01) in group CON and group MP,respectively.The CAS was decreased in group CON (P ＜ 0.01).Compared with preoperative records,the degree of diplopia was not significantly different in group CON (U =131.0,P =0.309) and group MP (U =157.5,P =0.881).Diplopia resolved in 7 cases(39％) of group CON,5 cases (28％) of group MP.New-onset dipopia or its aggravation was recorded in 3 cases(17％) of group CON,4 cases(22％) of group MP.The other postoperative improvement included recovered color vision,reduced intraocular pressure,and healing keratopathy.The important complications were intraoperative dural tears,new-onset diplopia and ocular inferior displacement.Conclusions The modified orbital decompression offers wide exposure to the three orbital walls,marked proptosis reduction,and no apparent scar.It is efficacious and safety for the treatment of CON and inflammatory activity of TAO without serious complicaitions,meanwhile,has little risk of induced diplopia.
