本文選題：鞏膜隧道切口　切入點：玻璃體切割　出處：《大連醫(yī)科大學》2010年碩士論文　論文類型：學位論文

【摘要】： 目的：探討“三通道”自閉式鞏膜隧道切口用于20G玻璃體切割手術(shù)的可行性和應用效果。 方法：選取我院從2008年3月至2009年6月期間對31例(31眼)經(jīng)睫狀體平坦部行后部標準20G玻璃體切割手術(shù)的患者,對于所有術(shù)中患者,沿角鞏膜緣后1 mm做“倒L”形球結(jié)膜瓣,“三通道”切口采用自閉式鞏膜隧道切口,手術(shù)操作結(jié)束時,先拔出光導纖維和玻切頭,觀察切口閉合情況,是否存在滲漏(如切口持續(xù)滲漏,則用10—0絲線間斷縫合)最后拔出灌注管并平復隧道切口,再次觀察切口有無滲漏(如切口有滲漏,仍按上述方法縫合)。球結(jié)膜切口電凝封閉。術(shù)后隨診4-19個月,同時記錄術(shù)前、術(shù)后視力、眼壓,切口閉合情況及術(shù)中、術(shù)后各種并發(fā)癥。 結(jié)果：31例手術(shù)均順利完成,31眼93個鞏膜隧道切口中,85個切口在手術(shù)結(jié)束時能自行閉合,8個切口則需行間斷縫合,其中1例兩個器械切口需全部縫合,6例需縫合1個器械切口。31個灌注隧道切口全部自行閉合,需縫合的隧道切口均為器械切口,在手術(shù)結(jié)束時予以處理。術(shù)后第一天檢查,球結(jié)膜切口對合良好,球結(jié)膜下未見出血或少量不明顯,球結(jié)膜充血水腫不明顯,未見球結(jié)膜下的異常滲漏,術(shù)后2周對切口行UBM檢查見自閉式鞏膜隧道切口對合整齊,線狀閉合�；颊咭暳胁煌潭忍岣摺ｋS訪病例無鋸齒緣斷離、周邊視網(wǎng)膜裂孔及視網(wǎng)膜脫離發(fā)生,無玻璃體再次出血等并發(fā)癥的發(fā)生 結(jié)論：“三通道”鞏膜隧道切口應用于常規(guī)20G玻璃體切割手術(shù),具有眼球密閉好,術(shù)中眼壓平穩(wěn),術(shù)后切口自閉型良好,術(shù)后炎癥反應輕、恢復快,同時降低了因切口縫合而產(chǎn)生相關(guān)并發(fā)癥等優(yōu)點。手術(shù)術(shù)式安全、無明顯術(shù)中術(shù)后并發(fā)癥。在現(xiàn)階段可以替代23G和25G實現(xiàn)無縫合的微創(chuàng)玻璃體切割手術(shù),值得在臨床應用。
[Abstract]:Objective: to investigate the feasibility and effect of three-channel self-closing scleral tunnel incision for 20 G vitrectomy. Methods: from March 2008 to June 2009, 31 patients (31 eyes) underwent posterior standard 20G vitrectomy through the flat part of the ciliary body. The "inverted L" conjunctival flap was made 1 mm behind the edge of the horn sclera. The "three-channel" incision was made with the self-closing scleral tunnel incision. At the end of the operation, the optical fiber and the glassy head were pulled out first, and the closure of the incision was observed. Whether there is leakage (if the incision continues to leak, by intermittent suturing with 10-0 filaments) and finally pulling out the perfusion tube and leveling the tunnel incision, and observing again whether there is leakage in the incision (if there is leakage in the incision, The conjunctival incision was closed by electric coagulation. The postoperative follow-up was 4 to 19 months. The preoperative and postoperative visual acuity, intraocular pressure, incision closure and complications were recorded. Results of the 93 scleral tunnel incisions in 31 eyes successfully completed in 31 cases, 85 incisions could be closed by themselves at the end of the operation, and 8 incisions needed to be sutured intermittently. Among them, 1 case with two instrument incisions needed to be sutured completely and 6 cases needed to suture 1 instrument incision. All 31 perfusion tunnel incisions were closed by themselves, and all the tunnel incisions needed to be sutured were instrumentation incisions, which were treated at the end of operation, and examined on the first day after operation. The bulbar conjunctiva incision had good involution, there was no bleeding or small amount of subconjunctival hemorrhage, no obvious hyperemia and edema, no abnormal leakage under the bulbar conjunctiva. 2 weeks after operation, UBM examination of the incision showed that the osseous scleral tunnel incision was involuted neatly, and the conjunctival hyperemia edema was not obvious. Linear closure. The visual acuity of the patients were improved in varying degrees. There were no complications such as serrated edge breakage, peripheral retinal rupture and retinal detachment, no vitreous rebleeding and so on. Conclusion: the application of "three-channel" scleral tunnel incision in routine 20G vitrectomy has good eye closure, stable intraoperative intraocular pressure, good self-closing incision after operation, light inflammatory reaction after operation and quick recovery. At the same time, it can reduce the advantages of complications caused by incision suture. The operation is safe and has no obvious postoperative complications. It can replace 23G and 25G to realize seamless minimally invasive vitrectomy at the present stage, which is worthy of clinical application.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2010
【分類號】：R779.6

【參考文獻】

相關(guān)期刊論文 前6條

1 陳偉奇,劉應鵬,詹行楷,李立梅,周忠廈,林順潮;改良自閉式鞏膜隧道切口應用研究[J];中國醫(yī)師雜志;2005年09期

2 陳偉奇,詹行楷,劉應鵬,閆亦農(nóng),唐慧明,林順潮;鞏膜隧道切口用于玻璃體切割術(shù)的研究[J];汕頭大學醫(yī)學院學報;2002年02期

3 劉文,唐仕波,黃素英,張平,梁忠英,李加青,鄭湖玲;玻璃體手術(shù)中鞏膜穿刺孔脫出物的組織病理學檢查[J];中華眼底病雜志;2001年02期

4 唐仕波,賴銘瑩,李加青,李雙農(nóng);表面麻醉下25G經(jīng)結(jié)膜無縫合玻璃體視網(wǎng)膜手術(shù)的臨床應用[J];中華眼底病雜志;2004年03期

5 李雙農(nóng),唐仕波,李加青,賴銘瑩,白寧艷,高藝;25G經(jīng)結(jié)膜無縫線玻璃體切除手術(shù)系統(tǒng)的初步臨床應用效果[J];中華眼科雜志;2004年06期

6 項奕,邢怡橋,楊安懷,艾明,喻長泰;鞏膜隧道切口在玻璃體切割術(shù)中應用[J];中國實用眼科雜志;2003年10期

，

本文編號：1624700