本文選題：晶狀體不全脫位 + 小切口手術(shù)��； 參考：《大連醫(yī)科大學(xué)》2010年碩士論文

【摘要】： 目的：晶狀體不全脫位可導(dǎo)致視力下降、視物變形,也可引起繼發(fā)性青光眼、視網(wǎng)膜脫離等并發(fā)癥,其手術(shù)治療較為復(fù)雜且棘手,傳統(tǒng)大切口手術(shù)存在視力恢復(fù)不理想,手術(shù)并發(fā)癥多,恢復(fù)時(shí)間長(zhǎng)等不足。近年來(lái)隨著眼科手術(shù)設(shè)備的日趨完善和手術(shù)技巧的不斷提高,以及手術(shù)新技術(shù)、新材料的引入,使現(xiàn)代晶狀體不全脫位手術(shù)向著微創(chuàng)小切口手術(shù)方向發(fā)展,術(shù)后視功能明顯改善,大大地減少手術(shù)并發(fā)癥,并且有效地縮短恢復(fù)時(shí)間,從而擴(kuò)大了晶狀體不全脫位治療的手術(shù)適應(yīng)癥。本文旨在探討在治療晶狀體不全脫位中不同方式現(xiàn)代小切口手術(shù)的治療技巧以及術(shù)后臨床療效的觀察。 方法：回顧性研究自2008年8月至2009年10月在大連醫(yī)科大學(xué)附屬二院因晶狀體不全脫位而行小切口晶狀體手術(shù)治療的一組患者共20例21眼。晶狀體脫位范圍均在1/3-2個(gè)象限內(nèi),9眼脫位范圍在1-2個(gè)象限之內(nèi),其中上方脫位5眼,鼻側(cè)脫位2眼,下方脫位2眼；12眼脫位范圍1個(gè)象限。根據(jù)晶狀體不全脫位范圍和位置,分別采用以下2種手術(shù)方法：1.晶狀體脫位范圍1個(gè)象限及脫位范圍在1-2個(gè)象限之內(nèi)下方脫位的14眼采用單純超聲乳化晶狀體吸除聯(lián)合折疊式后房型人工晶狀體植入術(shù);2.晶狀體脫位范圍在1-2個(gè)象限之內(nèi)的余下7眼采用超聲乳化晶狀體吸除聯(lián)合囊袋張力環(huán)及折疊式后房型人工晶狀體植入術(shù)(其中1眼虹膜部分缺損且脫位范圍較大聯(lián)合虹膜拉鉤囊袋固定)。術(shù)后觀察最佳矯正視力、眼壓、人工晶狀體位置以及手術(shù)并發(fā)癥。 結(jié)果：所有21眼均順利完成手術(shù),人工晶狀體一期植入囊袋內(nèi)。術(shù)后3個(gè)月最佳矯正視力較術(shù)前明顯提高,差異具有非常明顯的統(tǒng)計(jì)學(xué)意義(t=-10.45,P0.01)；兩種手術(shù)方式間最佳矯正視力的提高,其差異不具有統(tǒng)計(jì)學(xué)意義(t=1.74,P0.05)。術(shù)后眼壓較術(shù)前明顯減低,差異具有明顯的統(tǒng)計(jì)學(xué)意義(t=2.84,P0.05)；兩種手術(shù)方式間眼壓的降低,其差異不具有統(tǒng)計(jì)學(xué)意義(t=-0.87,P0.05)。兩種手術(shù)方式人工晶狀體正位率的差異不具有統(tǒng)計(jì)學(xué)意義(Fisher確切概率法,P=0.750.05)。兩種手術(shù)方式均未見(jiàn)嚴(yán)重或特殊并發(fā)癥。兩種手術(shù)方式間的術(shù)后反應(yīng),其差異不具有統(tǒng)計(jì)學(xué)意義(Fisher確切概率法,P角膜水腫=0.44,P虹膜炎性反應(yīng)=0.56,P高眼壓=0.25,P后囊膜混濁=0.57,P0.05)。 結(jié)論：在晶狀體不全脫位的現(xiàn)代手術(shù)治療中,根據(jù)患者和醫(yī)生的具體情況選擇最適宜的微創(chuàng)小切口手術(shù)方式,并充分運(yùn)用現(xiàn)代眼科新技術(shù),有利于患者視功能的改善以及術(shù)中和術(shù)后并反癥的減少。
[Abstract]:Objective: lens incomplete dislocation can lead to vision loss, visual distortion, secondary glaucoma, retinal detachment and other complications, its surgical treatment is more complex and difficult, traditional large incision surgery has poor recovery of vision. There are many complications and long recovery time. In recent years, with the improvement of the equipment and technique of ophthalmic surgery, and the introduction of new techniques and materials, modern lens dislocations have been developed towards the direction of minimally invasive small-incision surgery. The postoperative visual function was improved significantly, the complications were reduced, and the recovery time was shortened effectively, thus expanding the operative indications for the treatment of incomplete lens dislocation. The purpose of this paper is to explore the treatment techniques and clinical effect of different kinds of modern small incision surgery in the treatment of incomplete lens dislocation. Methods: from August 2008 to October 2009, a group of 20 cases (21 eyes) with small incision lens surgery was performed in the second affiliated Hospital of Dalian Medical University. The range of dislocation of lens was within 1 / 3 ~ 2 quadrants and 9 eyes were within 1-2 quadrants, including 5 eyes with upper dislocation, 2 eyes with nasal dislocation, and 12 eyes with dislocation under 2 eyes. According to the range and location of incomplete dislocation of the lens, the following two surgical procedures: 1: 1 were used. Phacoemulsification combined with foldable posterior chamber intraocular lens implantation was performed in 14 eyes with dislocation range of 1 quadrant and 1-2 quadrants. The remaining 7 eyes with dislocation range within 1-2 quadrants were treated with phacoemulsification combined with capsular tension ring and foldable posterior chamber intraocular lens implantation (1 eye with partial iris defect and large dislocation range). Combined with iris retractor bag to fix the pouch. Postoperative best corrected visual acuity, intraocular pressure, intraocular lens location and surgical complications were observed. Results: all 21 eyes were successfully operated and intraocular lens was implanted into the capsule. The best corrected visual acuity (BCVA) at 3 months after operation was significantly higher than that before operation, and the difference was statistically significant (P 0.01), and the difference between the two kinds of operation methods was not statistically significant. The IOP after operation was significantly lower than that before operation, and the difference was statistically significant (P 0.05), but there was no significant difference in IOP between the two types of operation. There was no significant difference in the positive position rate of intraocular lens between the two surgical methods. There were no severe or special complications in either operation. There was no significant difference in postoperative reaction between the two methods. Fisher's exact probability method suggested that P corneal edema was 0.44m P iridoinflammatory response was 0.56p high intraocular pressure 0.25m P posterior capsular opacification was 0.57m P0.05m. Conclusion: in the modern surgical treatment of incomplete lens dislocation, the most suitable minimally invasive small incision operation is selected according to the specific conditions of the patients and doctors, and the new modern ophthalmic technique is fully utilized. It is beneficial to the improvement of visual function and the reduction of intraoperative and postoperative complications.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R779.6

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