本文關(guān)鍵詞： 扭動(dòng)模式 白內(nèi)障 超聲乳化 角膜內(nèi)皮細(xì)胞　出處：《山東大學(xué)》2010年碩士論文　論文類型：學(xué)位論文

【摘要】： 【目的】白內(nèi)障是世界范圍內(nèi)主要的致盲眼病,到目前為止,白內(nèi)障手術(shù)摘除合并人工晶體植入仍是公認(rèn)的白內(nèi)障治療最有效的手段。白內(nèi)障手術(shù)日趨完美,已經(jīng)成為屈光意義的手術(shù),白內(nèi)障超聲乳化手術(shù)已經(jīng)成為大多數(shù)眼科醫(yī)生治療白內(nèi)障的首選術(shù)式。然而超聲乳化手術(shù)中超聲波會(huì)對(duì)眼組織產(chǎn)生一定損傷,因此盡可能減少超聲能量對(duì)眼組織的損傷一直是眼科醫(yī)生關(guān)注的課題。一種新型的超聲乳化模式——扭動(dòng)模式,可以提高白內(nèi)障超聲乳化的效率,減輕角膜內(nèi)皮損傷。本研究目的在于探討混合超聲動(dòng)力模式(扭動(dòng)模式聯(lián)合往復(fù)模式)應(yīng)用于白內(nèi)障超聲乳化吸除術(shù)的安全性及有效性。 【方法】本研究為前瞻性研究。病例均來(lái)自山東大學(xué)附屬濟(jì)南市中心醫(yī)院,術(shù)前診斷年齡相關(guān)性白內(nèi)障,共266例(291眼)。術(shù)前按照登記順序隨機(jī)分為3組,傳統(tǒng)組(往復(fù)超聲模式)97眼,混合組(扭動(dòng)+往復(fù)模式)98眼,扭動(dòng)組(單純扭動(dòng)模式)96眼。術(shù)前排除患有其它眼科疾病以及影響視力的疾病。在2.2mm微切口下分別使用傳統(tǒng)模式、混合模式、扭動(dòng)模式乳化吸除晶狀體核組織。記錄并比較術(shù)中所使用的超聲時(shí)間(UST)、超聲能量(CDE)、術(shù)后1d、7d角膜水腫程度、最佳矯正視力,術(shù)后7d、1個(gè)月角膜內(nèi)皮細(xì)胞數(shù)和角膜內(nèi)皮細(xì)胞丟失率。 【結(jié)果】UST比較：傳統(tǒng)組Ⅱ級(jí)核17.80±5.55秒,Ⅲ級(jí)核30.54±5.23秒,Ⅳ-Ⅴ級(jí)核52.01±15.43秒；混合組Ⅱ級(jí)核14.22±3.99秒,Ⅲ級(jí)核23.46±6.00秒,Ⅳ-Ⅴ級(jí)核38.93±12.09秒；扭動(dòng)組Ⅱ級(jí)核13.75±6.03秒；Ⅲ級(jí)核25.65±5.42秒,Ⅳ-Ⅴ級(jí)核39.62±11.46秒,3組之間比較差異有統(tǒng)計(jì)學(xué)意義,P0.05。CDE比較：傳統(tǒng)組Ⅱ級(jí)核5.84%±2.23%,Ⅲ級(jí)核10.66%±3.06%,Ⅳ-Ⅴ級(jí)核18.79%±5.46%；混合組Ⅱ級(jí)核3.88%±1.74%,Ⅲ級(jí)核8.47%±1.79%,Ⅳ-Ⅴ級(jí)核14.82%±5.57%；扭動(dòng)組Ⅱ級(jí)核3.65%±1.72%,Ⅲ級(jí)核8.23%±3.04%,Ⅳ-Ⅴ級(jí)核14.85%±4.33%,3組之間比較差異有統(tǒng)計(jì)學(xué)意義,P0.05。UST和CDE在Ⅱ,Ⅲ及Ⅳ-Ⅴ級(jí)硬度核中,傳統(tǒng)組均大于混合組和扭動(dòng)組,且隨核硬度增加而增加,差異有統(tǒng)計(jì)學(xué)意義；扭動(dòng)組與混合組差異無(wú)統(tǒng)計(jì)學(xué)意義。術(shù)后角膜水腫程度：術(shù)后1天及7天,混合模式組與扭動(dòng)模式組均輕于傳統(tǒng)模式組,差異具有統(tǒng)計(jì)學(xué)意義,P0.05,術(shù)后1月3組均無(wú)角膜水腫。術(shù)后最佳矯正視力(BCVA)：術(shù)后1天及7天,混合模式組與扭動(dòng)模式組均好于傳統(tǒng)模式組,差異具有統(tǒng)計(jì)學(xué)意義,P0.05,術(shù)后1月,3組比較差異無(wú)統(tǒng)計(jì)學(xué)意義,P0.05。 【結(jié)論】混合超聲模式與扭動(dòng)模式相仿,可減少術(shù)中超聲能量和超聲時(shí)間,增加核的追隨性,減低排斥力,提高乳化效率。明顯減輕患者角膜內(nèi)皮細(xì)胞的損傷,角膜恢復(fù)快于傳統(tǒng)模式,短時(shí)間內(nèi)即可獲得良好的視覺(jué)效果,較傳統(tǒng)超聲模式更為安全有效。在硬核處理中,混合模式對(duì)減少超乳管道阻塞和視野霧化程度方面都優(yōu)于單純使用扭動(dòng)模式,為硬核白內(nèi)障提供了更為有效安全的超聲乳化動(dòng)力模式。
[Abstract]:[objective] Cataract is the leading cause of blindness in the world, so far, cataract surgery with intraocular lens implantation is still recognized as the most effective means of cataract treatment, cataract surgery is becoming more and more perfect. Phacoemulsification has become the first choice for most ophthalmologists in the treatment of cataract. However, ultrasound can cause some damage to ocular tissue in phacoemulsification. Therefore, minimizing the damage of ultrasonic energy to ocular tissue has been a focus of ophthalmologists. A new mode of phacoemulsification, torsion mode, can improve the efficiency of phacoemulsification of cataract. The purpose of this study was to investigate the safety and efficacy of hybrid ultrasound dynamic mode (torsion mode combined with reciprocating mode) in phacoemulsification of cataract. [methods] this study was a prospective study. All the patients were from Jinan Central Hospital affiliated to Shandong University and were diagnosed with age-related cataract before operation. A total of 266 cases (291 eyes) were randomly divided into three groups according to the order of registration before operation: the traditional group (97 eyes) and the mixed group (98 eyes). Torsion group (96 eyes with simple torsion mode. Other ophthalmic diseases and diseases affecting visual acuity were excluded before operation. Traditional mode and mixed mode were used under 2.2 mm microincision. Phacoemulsification in torsion mode was used to remove the nucleus of lens. The time of ultrasound used during operation was recorded and compared. The ultrasonic energy and CDEI were recorded and compared. The degree of corneal edema was 7 days after operation, and the best corrected visual acuity was obtained. The number of corneal endothelial cells and the rate of corneal endothelial cell loss were 1 month after operation. [results] UST comparison: in the traditional group, the nucleus of grade 鈪，

本文編號(hào)：1458211