【摘要】：目的：研究分析青少年患者行玻璃體視網(wǎng)膜手術(shù)治療的臨床特點(diǎn),對手術(shù)相關(guān)的各因素綜合評價(jià),指導(dǎo)后續(xù)臨床工作。 方法：收集我院2006年1月至2010年12月間的年齡小于或等于18歲玻璃體切割術(shù)治療的青少年患者47例48眼,對其相關(guān)臨床資料行統(tǒng)計(jì)分析。依據(jù)病因不同分為兩組：原發(fā)性玻璃體視網(wǎng)膜病變組25例26眼,外傷性玻璃體視網(wǎng)膜病變組22例22眼。對其發(fā)病原因,手術(shù)方式,術(shù)中相關(guān)處置及預(yù)后進(jìn)行分析討論。 結(jié)果：全部病例中引發(fā)玻璃體視網(wǎng)膜疾病的主要原因?yàn)橥鈧?外傷性玻璃體視網(wǎng)膜病變占46.8%(22眼)。主要病理改變?yōu)橐暰W(wǎng)膜脫離共37眼(77.1%)。青少年患者術(shù)前增殖型玻璃體視網(wǎng)膜病變(proliferative vitreous retinopathy PVR)高發(fā)(36.1%),玻璃體后脫離(posterior detachment of vitreous PVD)發(fā)生率相對低(14.5%)。視網(wǎng)膜脫離范圍廣泛,大于兩象限以上者占62.1%且多累及黃斑區(qū)(59.4%)及顳側(cè)網(wǎng)膜(67.5%)。術(shù)中晶狀體切除和／或聯(lián)合人工晶體植入共9例,經(jīng)統(tǒng)計(jì)分析其并不影響預(yù)后視力。視網(wǎng)膜脫離范圍、脫離累及黃斑區(qū)及手術(shù)次數(shù)與預(yù)后視力行統(tǒng)計(jì)學(xué)分析,顯示上述因素對預(yù)后視力影響顯著。 結(jié)論：1、青少年患者行玻璃體切割術(shù)(pars plana vitrectomy PPV)治療主要原因?yàn)樾迯?fù)各型視網(wǎng)膜脫離,及伴發(fā)的不同程度的PVR。2、對于青少年患者PPV手術(shù)是否聯(lián)合行晶狀體處置應(yīng)根據(jù)具體情況謹(jǐn)慎選擇,對于預(yù)期可能行多次手術(shù)完成眼部解剖及功能修復(fù)的應(yīng)盡量選擇二期甚至三期手術(shù)。3、對于遠(yuǎn)期預(yù)后視力的主要影響因素為視網(wǎng)膜脫離范圍,脫離是否累及黃斑區(qū)及手術(shù)頻次。4、各病理因素引起的原發(fā)性疾病多數(shù)情況復(fù)雜,視網(wǎng)膜脫離范圍廣泛,手術(shù)復(fù)位難度較大且效果不佳,而外傷性玻璃體視網(wǎng)膜病變手術(shù)效果確切,預(yù)后視力相對理想。
[Abstract]:Objective: to analyze the clinical features of vitreoretinal surgery in adolescent patients and evaluate the related factors. Methods: from January 2006 to December 2010, 47 cases (48 eyes) of young patients under 18 years old treated by vitrectomy in our hospital were collected and their clinical data were analyzed statistically. The patients were divided into two groups according to the etiology: 25 cases (26 eyes) with primary vitreoretinopathy and 22 cases (22 eyes) with traumatic vitreoretinopathy. The etiology, surgical methods, intraoperative treatment and prognosis were analyzed and discussed. Results: trauma was the main cause of vitreoretinopathy in all cases. Traumatic vitreoretinopathy accounted for 46.8% (22 eyes). The main pathological changes were retinal detachment in 37 eyes (77.1%). The incidence of proliferative vitreoretinopathy (proliferative vitreous retinopathy PVR) was high (36.1%) and the incidence of posterior vitreous detachment (posterior detachment of vitreous PVD) was relatively low (14.5%). The range of retinal detachment was wide, more than two quadrants (62.1%), macular area (59.4%) and temporal omentum (67.5%). Intraoperative lens resection and / or intraocular lens implantation were performed in 9 cases. The range of retinal detachment, macular area and the number of operations and the prognosis of visual acuity were statistically analyzed. The results showed that the above factors had a significant effect on the prognosis of visual acuity. Conclusion the main reason for (pars plana vitrectomy PPV) treatment of adolescent patients with vitrectomy is to repair various types of retinal detachment. And PVR.2with different degrees of PVR.2. whether or not PPV surgery is combined with lens management should be carefully selected according to the specific situation. For those who are expected to undergo multiple operations to complete ocular anatomy and functional repair, the second or third stage operation should be chosen as far as possible. The main influencing factor for the long-term prognosis of visual acuity is the range of retinal detachment. Whether the detachment involved macular area and the frequency of surgery. 4. Most of the primary diseases caused by pathological factors were complicated, the range of retinal detachment was extensive, the surgical reattachment was difficult and the effect was not good. The operative effect of traumatic vitreoretinopathy is accurate, and the prognosis of vitreoretinopathy is relatively ideal.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R774.1

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