發(fā)布時(shí)間：2018-05-23 19:06

  本文選題：]玻璃體切割術(shù) + 鞏膜扣帶術(shù)�。� 參考：《廣西醫(yī)科大學(xué)》2011年碩士論文

【摘要】：目的系統(tǒng)地評(píng)價(jià)玻璃體切割術(shù)(PPV)與鞏膜扣帶術(shù)(SB)治療非復(fù)雜性視網(wǎng)膜脫離的療效及手術(shù)安全性。 方法計(jì)算機(jī)檢索Cochrane圖書館,Pubmed, Embase, CNKI和CBM,以及SCI數(shù)據(jù)庫(kù)及手工檢索,收集比較PPV與SB治療非復(fù)雜性視網(wǎng)膜脫離的隨機(jī)對(duì)照研究(RCT)。運(yùn)用Cochrane協(xié)作網(wǎng)提供的質(zhì)量評(píng)價(jià)標(biāo)準(zhǔn)評(píng)價(jià)納入研究的方法學(xué)質(zhì)量,提取有效數(shù)據(jù),采用Revman 5.0軟件根據(jù)晶狀體情況分成兩個(gè)亞組進(jìn)行統(tǒng)計(jì)分析,比較PPV與SB治療非復(fù)雜性視網(wǎng)膜脫離術(shù)后的最佳矯正視力(BCVA)的變化,初次手術(shù)及最終視網(wǎng)膜復(fù)位率及并發(fā)癥的發(fā)生率。 結(jié)果共納入6篇RCTs (共1213人)。3個(gè)RCTs只納入了人工晶體或無晶體眼的病人,2個(gè)RCTs納入有晶體眼的病人,另一個(gè)研究則納入了這兩類的病人。Meta分析的結(jié)果顯示: BCVA的提高上:有晶體眼組MD= 0.14, 95% CI (0.01,0.27);人工晶體眼/無晶體眼組MD= 0.07, 95% CI (0.01,0.13),這表明PPV比SB術(shù)后最佳矯正視力提高更顯著。在視網(wǎng)膜復(fù)位率上,PPV與SB在初次手術(shù)視網(wǎng)膜復(fù)位率[有晶體眼組RR= 1.0, 95% CI (0.9,1.11),人工晶體眼/無晶體眼組RR= 1.12, 95% CI (0.97,1.3)]與最終視網(wǎng)膜復(fù)位率上[有晶體眼組RD= -0.00, 95% CI (-0.03,0.03),人工晶體眼/無晶體眼組RD= 0.03,95% CI (-0.00,0.06)]均無明顯差異。 結(jié)論無論有晶體眼還是人工晶體眼/無晶體眼,PPV在BCVA的提高上明顯優(yōu)于SB,而在視網(wǎng)膜的復(fù)位率上二者無顯著性差異。兩種手術(shù)的并發(fā)癥情況不盡相同:與SB相比,PPV在增殖性玻璃體視網(wǎng)膜病變(PVR)發(fā)生率、脈絡(luò)膜脫離發(fā)生率、再次手術(shù)率、屈光改變、眼軸的變化及手術(shù)時(shí)間上占有一定的優(yōu)勢(shì);但是在醫(yī)源性裂孔及并發(fā)性白內(nèi)障的發(fā)生率上恰恰相反。由于納入的各研究有限,所得結(jié)論需要進(jìn)一步的研究證實(shí)。
[Abstract]:Objective to evaluate the efficacy and safety of vitrectomy and scleral buckling in the treatment of non-complicated retinal detachment. Methods Cochrane libraries were searched by computer for pubmeda, Embase, CNKI and CBM, SCI database and manual retrieval. The randomized controlled study of PPV and SB in the treatment of non-complex retinal detachment was collected and compared. The quality evaluation standard provided by Cochrane cooperation network was used to evaluate the methodological quality of the study, and the valid data were extracted. The software Revman 5.0 was used to divide the two subgroups according to the lens condition for statistical analysis. To compare the changes of best corrected visual acuity (BCVA), the rate of first and final retinal reattachment and the incidence of complications after PPV and SB in the treatment of non-complicated retinal detachment. Results A total of 6 RCTs articles were included (1213 patients). 3 RCTs patients only included intraocular lens or aphakic eyes, and 2 RCTs patients with lens eyes. The other study included two groups of patients. Meta-analysis showed that the increase of BCVA was: MD0.14,95% CI 0.01U 0.27 in the group with lens eye, MD0.07,95% CI 0.01C 0.13 in IOL / acrystalline eyes, which indicated that the improvement of PPV was more significant than that of the best corrected visual acuity after SB. At the rate of retinal reattachment, PPV and SB were found in the primary retinal reattachment rate (RR = 1.0, 95% CI 0.9 1.11, RR = 1.12, 95% CI 0.971.3) and the final retinal reattachment rate [RD = -0.00, 95% CI -0.03] and the final retinal reattachment rate (RD = -0.00, 95% CI = -0.030.03) in the intraocular eye group (RR = 1.0, 95% CI = 0.9%, RR = 1.12, 95% CI 0.971.3%) and the final retinal reattachment rate in the lens eye group. There was no significant difference in RD = 0.03 ~ 95% CI ~ (-0.000. 06)] between IOL eyes and Aphakic eyes. Conclusion both intraocular and intraocular lens eyes / Aphakic eyes can significantly improve BCVA, but there is no significant difference in the rate of retinal reattachment between the two groups. The complications of the two operations were different: compared with SB, PPV had some advantages in the incidence of proliferative vitreoretinopathy (PVR), choroidal detachment, reoperation rate, refractive change, axial change and operation time. However, the incidence of iatrogenic hiatus and cataract is quite the opposite. Due to the limited number of studies included, the conclusions need to be confirmed by further studies.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類號(hào)】：R779.6

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