中外医疗
中外醫療
중외의료
CHINA FOREIGN MEDICAL TREATMENT
2015年
22期
97-99
,共3页
角膜溃疡%结膜筋膜瓣遮盖%板层角膜切除%老年
角膜潰瘍%結膜觔膜瓣遮蓋%闆層角膜切除%老年
각막궤양%결막근막판차개%판층각막절제%노년
Keratohelcosis%Conjunctival-fascial flap covering%Famellar keratoplasty%Senile
目的：探讨应用深板层角膜切除联合全角膜结膜筋膜瓣遮盖术治疗老年严重角膜溃疡的治疗效果。方法回顾性分析2006年1月-2013年4月在该院确诊的严重角膜溃疡(无穿孔)老年患者55例(55眼)，经2周全身和局部用药治疗无效，或病情加重，不愿或不能接受角膜移植，行深板层角膜切除联合全角膜结膜筋膜瓣遮盖术，术后对原发病继续药物治疗，15~20 d拆线。术后随访3~9个月。结果术后54例患者角膜刺激症状明显减轻，1个月后消失，2~3个月时角结膜筋膜厚度稳定，接近1/2角膜厚度，溃疡全部愈合，未见角膜穿孔、角膜葡萄肿等并发症。1眼出现角膜溶解、重度眼内炎，行眼内容剜除术。总治愈率98.2%。55眼中40眼术后视力较术前有提高，占(72.7%)，与术前相比差异有统计学意义(χ2=10.03，P<0.05)。结论对药物治疗无效的采用深板层角膜切除联合全角膜结膜筋膜瓣遮盖术可以治愈老年严重角膜溃疡，保存眼球。并发重度眼内炎者可行眼内容剜除术。
目的：探討應用深闆層角膜切除聯閤全角膜結膜觔膜瓣遮蓋術治療老年嚴重角膜潰瘍的治療效果。方法迴顧性分析2006年1月-2013年4月在該院確診的嚴重角膜潰瘍(無穿孔)老年患者55例(55眼)，經2週全身和跼部用藥治療無效，或病情加重，不願或不能接受角膜移植，行深闆層角膜切除聯閤全角膜結膜觔膜瓣遮蓋術，術後對原髮病繼續藥物治療，15~20 d拆線。術後隨訪3~9箇月。結果術後54例患者角膜刺激癥狀明顯減輕，1箇月後消失，2~3箇月時角結膜觔膜厚度穩定，接近1/2角膜厚度，潰瘍全部愈閤，未見角膜穿孔、角膜葡萄腫等併髮癥。1眼齣現角膜溶解、重度眼內炎，行眼內容剜除術。總治愈率98.2%。55眼中40眼術後視力較術前有提高，佔(72.7%)，與術前相比差異有統計學意義(χ2=10.03，P<0.05)。結論對藥物治療無效的採用深闆層角膜切除聯閤全角膜結膜觔膜瓣遮蓋術可以治愈老年嚴重角膜潰瘍，保存眼毬。併髮重度眼內炎者可行眼內容剜除術。
목적：탐토응용심판층각막절제연합전각막결막근막판차개술치료노년엄중각막궤양적치료효과。방법회고성분석2006년1월-2013년4월재해원학진적엄중각막궤양(무천공)노년환자55례(55안)，경2주전신화국부용약치료무효，혹병정가중，불원혹불능접수각막이식，행심판층각막절제연합전각막결막근막판차개술，술후대원발병계속약물치료，15~20 d탁선。술후수방3~9개월。결과술후54례환자각막자격증상명현감경，1개월후소실，2~3개월시각결막근막후도은정，접근1/2각막후도，궤양전부유합，미견각막천공、각막포도종등병발증。1안출현각막용해、중도안내염，행안내용완제술。총치유솔98.2%。55안중40안술후시력교술전유제고，점(72.7%)，여술전상비차이유통계학의의(χ2=10.03，P<0.05)。결론대약물치료무효적채용심판층각막절제연합전각막결막근막판차개술가이치유노년엄중각막궤양，보존안구。병발중도안내염자가행안내용완제술。
Objective To observe the effect of deeper lamellar keratoplasty combined with total corneal conjunctival-fascial flap covering surgery in the treatment of senile severe keratohelcosis. Methods A retrospective analysis on clinical data was performed on 55 senile cases (55 eyes) who were diagnosed severe keratohelcosis (no perforation) in our hospital form January 2006 to April 2013. It was invalid with 2 weeks of systemic and topical medication treatment, and they were unwilling or unable to accept the corneal transplantation. The surgery of deeper lamellar keratoplasty combined with total corneal conjunctival-fascial flap covering were performed, and further postoperative drug treatment was based on the primary diseases, stitched at 15-20 days postoperative-ly, they were followed up for 3~9 months. Results In 54 cases, corneal irritation symptoms reduced significantly postoperatively, and disappeared at 1 month or so, the thickness of conjunctiva-fascia-cornea was near to 1/2 normal corneal thickness at 2~3 months, keratohelcosis healed eventually, without complications, such as corneal perforation, corneal staphyloma etc. One case was complicated with corneal lysis, severe endophthalmitis, and ocular evisceration was applied finally. The total cure rate was 98.2%. Visual acuity of 40 eyes (72.7%) was improved postoperatively, there were statistical differences between visual acuity of pre-oper-ation and post-operation (χ2=10.03,P<0.05). Conclusion It is effective for deeper lamellar keratoplasty combined with total corneal conjunctival and fascial flap covering surgery which could cure keratohelcosis and save the eyeball, in the treatment of elderly pa-tients with severe keratohelcosis, in whom severe endophthalmitis can be treated with ocular evisceration once it is found.
