嚴(yán)重鞏膜破裂傷眼后段結(jié)構(gòu)重建的臨床研究
發(fā)布時間：2018-10-22 19:36
【摘要】：研究背景和目的 嚴(yán)重鞏膜破裂傷是目前眼科住院病人中眼球摘除率最高的一類眼科急癥,也是最難處理的一類眼科疾病。隨著眼科手術(shù)器械及手術(shù)技巧的不斷進(jìn)步,特別是玻璃體切除術(shù)(Pars plana vitrectomy,PPV)的出現(xiàn),更大程度上提高了眼外傷的救治效果,使得以前頻臨摘除的患眼,避免了眼球摘除,不僅恢復(fù)了眼球的解剖結(jié)構(gòu),而且視力也得到不同程度的提高。眼外傷的治療理念在不斷探究中發(fā)展進(jìn)步,仍有許多問題的解決方法有待探討。而且眼外傷的分類、分級、分區(qū)及無光感外傷眼的救治,早期眼球萎縮的治療方法,眼球摘除的適應(yīng)癥,眼外傷手術(shù)時機(jī)及多次治療原因及方法等都是目前眼科醫(yī)師探求和爭議的焦點(diǎn)。 本研究的目的在于探討嚴(yán)重鞏膜破裂傷的治療方案及不同部位嚴(yán)重鞏膜破裂傷眼后段結(jié)構(gòu)重建術(shù)后的治療效果。希望能夠?yàn)橐院蟠祟惒∪说闹委熖峁┛茖W(xué)的循證方法,并且能對此類疾病的治療提供一些新的理念。使得嚴(yán)重鞏膜破裂傷這種傷害能得到最大限度的治療。 方法 收集2009年1月至2012年1月期間在我院行PPV的嚴(yán)重鞏膜破裂傷病例共46例46眼,包括性別、年齡、職業(yè)、致傷原因等一般資料。所有患者根據(jù)其耐受程度選取全身麻醉或是局部麻醉手術(shù)治療。術(shù)中根據(jù)眼部情況聯(lián)合晶狀體切除,重水輔助壓平視網(wǎng)膜,剝除視網(wǎng)膜增生膜,水下電凝止血,光凝視網(wǎng)膜裂孔和變性區(qū),視網(wǎng)膜切開或切除,眼內(nèi)填充硅油或C3F8氣體。隨訪時間大于3月。隨訪期間收集的資料包括：在院期間的視力、眼壓、前房積血、視網(wǎng)膜復(fù)位、增殖性玻璃體視網(wǎng)膜病變(proliferative vitreoretinopathy,PVR)情況等,出院后1月、2月、3月及以后每次復(fù)查時最佳矯正視力(Best corrected visual acuity,BCVA)及眼壓、視網(wǎng)膜復(fù)位、并發(fā)癥等情況。所有數(shù)據(jù)采用SPSS15.0統(tǒng)計學(xué)軟件包進(jìn)行處理。 結(jié)果 1.玻璃體切除術(shù)聯(lián)合脈絡(luò)膜和視網(wǎng)膜復(fù)位方法治療嚴(yán)重鞏膜破裂傷效果顯著,視力均有不同程度的提高。術(shù)后最佳矯正視力NLP-HM者21眼,CF-0.04者7眼,0.05～1.0者18眼,其中術(shù)眼BCVA1.0者1眼,0.9者1眼。 2.不同部位鞏膜破裂傷手術(shù)效果不同,傷口最后端超出角膜緣后l0mm的,視力提高的可能性僅15.38%,而且長期隨訪眼球萎縮率比較大,占30.77%。 3.玻璃體切除聯(lián)術(shù)合眼內(nèi)填充手術(shù)改善了術(shù)前低眼壓的狀況。術(shù)前眼壓1OmmHg者44眼,眼壓10～21mmHg者2眼；術(shù)后眼壓＜10mmHg者6眼,眼壓10～21mmHg者40眼,其中1眼術(shù)后早期眼壓21mmHg, PPV術(shù)后2月行睫狀體光凝術(shù)后眼壓降至正常。 4.嚴(yán)重鞏膜破裂傷通過行玻璃體切除手術(shù)及術(shù)中脈絡(luò)膜、視網(wǎng)膜復(fù)位方法,避免了眼球摘除,降低了眼球萎縮及摘除比例,長期隨訪發(fā)現(xiàn)眼球萎縮比例為13.04%。 結(jié)論 嚴(yán)重鞏膜破裂傷行PPV后,視網(wǎng)膜最終復(fù)位率、視力均得到不同程度的提高。不同區(qū)域的傷口及傷口長度,眼外傷預(yù)后差別很大。行玻璃體切除術(shù)后,能夠改善術(shù)前的低眼壓情況,降低了眼球萎縮的發(fā)生。對于能夠縫合的眼球,應(yīng)盡量縫合,以求眼球初期解剖結(jié)構(gòu)恢復(fù),不要輕易行眼球摘除,為Ⅰ期或Ⅱ期做PPV聯(lián)合硅油注入術(shù)做準(zhǔn)備。
[Abstract]:Background and purpose of study Severe scleral rupture is one of the most difficult ophthalmic emergencies in ophthalmic inpatients, and it is also the most difficult category of ophthalmology With the progress of ophthalmic surgical instruments and surgical techniques, especially the appearance of Pars plana vitrectomy (PPV), the treatment effect of ocular trauma is improved, so as to avoid eye removal, and not only the eyeball's anatomy is restored. The structure, and the vision is also different There are many problems to be solved in the treatment of ocular trauma, and there are still many problems to be solved. Objective: To explore the classification, classification, zoning of ocular trauma and the treatment of ocular trauma, the treatment of early eyeball atrophy, the indication of eyeball extirpation, the time of ocular trauma operation and the causes and methods of multiple treatments. The purpose of this study was to investigate the treatment regimen of severe scleral rupture and the post-operative reconstruction of the posterior segment of severe scleral rupture in different parts. It is desirable to provide a scientific evidence-based approach to the treatment of such patients and to provide a treatment for such diseases. Some new ideas. The damage to severe scleral rupture can be maximized. Limits Treatment. Methods 46 eyes, including sex, age and grade, were collected from January 2009 to January 2012 in severe scleral rupture of PPV in our hospital. General information such as industry, cause of injury, etc. All patients selected systemic anesthesia based on their tolerance Surgical treatment of intoxication or local anesthesia. Combined lens resection according to eye conditions, retinal detachment of retina, removal of retinal proliferative film, underwater electrocoagulation hemostasis, photocoagulation retinal breaks and degenerative areas, retinal incision or resection, eye Fill silicone oil or C3F8 Gas. Follow-up time was greater than 3 months. The data collected during follow-up included visual acuity, intraocular pressure, anterior chamber tenderness, retinal reset, proliferative vitreoretinopathy (PVR), etc. during the course of the hospital, and Best corrected visual acui for each review in January, February, March, and after discharge. ty, BCVA) and intraocular pressure, visual Metomental reduction, complications, etc. All data were SPSS15. 0 Series Results 1.Vitrectomy combined with choroid and retinal reposition to treat severe scleral rupture After operation, 21 eyes of NLP-HM, 7 eyes of CF-0.04 and 18 eyes of 0. 05 ~ 1. 0 were found. BCVA0.1 eyes, 0. 9, 1 eyes, 2. The surgical effect of scleral rupture in different parts was different, the final end of the wound was more than l0mm after the limbal edge, and the possibility of visual acuity improvement was only 15. 38%, and After long-term follow-up, the rate of eyeball atrophy was large, accounting for 30. 77%. Postoperative intraocular pressure (IOP) was 1OmmHg (44 eyes), intraocular pressure (IOP) was 10 ~ 21mmHg (2 eyes), intraocular pressure (IOP) was <10mmHg (6 eyes), intraocular pressure (IOP) was 10 ~ 21mmHg (40 eyes). g. The intraocular pressure after cyclophotocoagulation in 2 months after PPV was decreased to normal. 4. Severe scleral rupture was removed by vitrectomy and choroid and retinal reposition. contraction The ratio of extirpation and long-term follow-up showed that the proportion of eyeball atrophy was 13.04%. After scleral rupture, the retinal final reduction rate and visual acuity were determined after PPV. There was a significant difference in the prognosis of wound and wound in different regions. After vitrectomy, it is possible to improve the low intraocular pressure before operation and reduce the occurrence of atrophy of the eyeball. For the eyeball that can be sewn, the suture should be as close as possible, so that the initial anatomical structure of the eyeball can be restored.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R779.6
本文編號：2288108
[Abstract]:Background and purpose of study Severe scleral rupture is one of the most difficult ophthalmic emergencies in ophthalmic inpatients, and it is also the most difficult category of ophthalmology With the progress of ophthalmic surgical instruments and surgical techniques, especially the appearance of Pars plana vitrectomy (PPV), the treatment effect of ocular trauma is improved, so as to avoid eye removal, and not only the eyeball's anatomy is restored. The structure, and the vision is also different There are many problems to be solved in the treatment of ocular trauma, and there are still many problems to be solved. Objective: To explore the classification, classification, zoning of ocular trauma and the treatment of ocular trauma, the treatment of early eyeball atrophy, the indication of eyeball extirpation, the time of ocular trauma operation and the causes and methods of multiple treatments. The purpose of this study was to investigate the treatment regimen of severe scleral rupture and the post-operative reconstruction of the posterior segment of severe scleral rupture in different parts. It is desirable to provide a scientific evidence-based approach to the treatment of such patients and to provide a treatment for such diseases. Some new ideas. The damage to severe scleral rupture can be maximized. Limits Treatment. Methods 46 eyes, including sex, age and grade, were collected from January 2009 to January 2012 in severe scleral rupture of PPV in our hospital. General information such as industry, cause of injury, etc. All patients selected systemic anesthesia based on their tolerance Surgical treatment of intoxication or local anesthesia. Combined lens resection according to eye conditions, retinal detachment of retina, removal of retinal proliferative film, underwater electrocoagulation hemostasis, photocoagulation retinal breaks and degenerative areas, retinal incision or resection, eye Fill silicone oil or C3F8 Gas. Follow-up time was greater than 3 months. The data collected during follow-up included visual acuity, intraocular pressure, anterior chamber tenderness, retinal reset, proliferative vitreoretinopathy (PVR), etc. during the course of the hospital, and Best corrected visual acui for each review in January, February, March, and after discharge. ty, BCVA) and intraocular pressure, visual Metomental reduction, complications, etc. All data were SPSS15. 0 Series Results 1.Vitrectomy combined with choroid and retinal reposition to treat severe scleral rupture After operation, 21 eyes of NLP-HM, 7 eyes of CF-0.04 and 18 eyes of 0. 05 ~ 1. 0 were found. BCVA0.1 eyes, 0. 9, 1 eyes, 2. The surgical effect of scleral rupture in different parts was different, the final end of the wound was more than l0mm after the limbal edge, and the possibility of visual acuity improvement was only 15. 38%, and After long-term follow-up, the rate of eyeball atrophy was large, accounting for 30. 77%. Postoperative intraocular pressure (IOP) was 1OmmHg (44 eyes), intraocular pressure (IOP) was 10 ~ 21mmHg (2 eyes), intraocular pressure (IOP) was <10mmHg (6 eyes), intraocular pressure (IOP) was 10 ~ 21mmHg (40 eyes). g. The intraocular pressure after cyclophotocoagulation in 2 months after PPV was decreased to normal. 4. Severe scleral rupture was removed by vitrectomy and choroid and retinal reposition. contraction The ratio of extirpation and long-term follow-up showed that the proportion of eyeball atrophy was 13.04%. After scleral rupture, the retinal final reduction rate and visual acuity were determined after PPV. There was a significant difference in the prognosis of wound and wound in different regions. After vitrectomy, it is possible to improve the low intraocular pressure before operation and reduce the occurrence of atrophy of the eyeball. For the eyeball that can be sewn, the suture should be as close as possible, so that the initial anatomical structure of the eyeball can be restored.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R779.6
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