發(fā)布時(shí)間：2018-10-23 17:35

【摘要】：目的：對23-G經(jīng)結(jié)膜無縫合玻璃體手術(shù)與常規(guī)20-G玻璃體手術(shù)治療孔源性視網(wǎng)膜脫離進(jìn)行前瞻性臨床對比研究,為臨床醫(yī)師選擇手術(shù)方式提供參考依據(jù)。 方法：自2010年6月至2010年12月收集因孔源性視網(wǎng)膜脫離在青島大學(xué)醫(yī)學(xué)院附屬醫(yī)院眼科行玻璃體切割手術(shù)治療的患者,共52例52只眼,隨機(jī)分為23G組和20G組,所有手術(shù)由同一醫(yī)師完成,觀察對比各項(xiàng)指標(biāo)。 結(jié)果： 1.視力：最終矯正視力均較術(shù)前顯著提高(P0.01),視力提高程度除在術(shù)后7天,15天有差異外(P0.05),其他時(shí)間段兩組間無顯著差異(P0.05)。 2.眼壓：術(shù)后第1天23G組和20G組分別有3例和1例眼壓9mmHg,20G組中4例眼壓21mmHg,術(shù)前術(shù)后的眼壓變化兩組間無顯著性差異(P0.05)。 3.手術(shù)時(shí)間：兩組手術(shù)總時(shí)間無顯著差異(P0.05)。 4.角膜曲率：20G組術(shù)后1周,4周角膜曲率同術(shù)前相比變化具有統(tǒng)計(jì)學(xué)意義(P0.05),23G組僅術(shù)后1周變化較術(shù)前有統(tǒng)計(jì)學(xué)意義(P0.05)。 5.眼前節(jié)炎癥反應(yīng)：23G組的眼前節(jié)炎癥反應(yīng)程度均較20G組輕(P0.05)。 6.淚膜穩(wěn)定性：20G組患者術(shù)后早期角膜熒光染色、淚膜破裂時(shí)間、淚液分泌量均較23G組變化明顯,(P均0.05)。 7.患者舒適度：20G組患者的異物感、干澀感、流淚較23G組重(P0.05)；眼痛、眼癢、眼分泌物則無顯著差異(P0.05)。 8.切口并發(fā)癥：兩組切口玻璃體嵌頓和增殖物內(nèi)生沒有顯著差異(P0.05)。 9.術(shù)后并發(fā)癥：兩組術(shù)后出現(xiàn)一過性低眼壓和高眼壓；20G組出現(xiàn)1例視網(wǎng)膜再次脫離；23G組出現(xiàn)1例切口微滲漏；兩組均未發(fā)生眼內(nèi)炎。 結(jié)論：兩種手術(shù)方式均可有效治療原發(fā)性孔源性視網(wǎng)膜脫離,23G手術(shù)具有切口小,傷口恢復(fù)快,炎癥反應(yīng)輕,并發(fā)癥少,病人不適癥狀輕的特點(diǎn),但因23C玻璃體手術(shù)切口自閉,術(shù)后存在切口滲漏,發(fā)生眼內(nèi)炎的風(fēng)險(xiǎn)。
[Abstract]:Objective: to compare 23-G vitreous surgery with 20-G vitreous surgery in the treatment of rhegmatogenous retinal detachment. Methods: from June 2010 to December 2010, 52 patients (52 eyes) with rhegmatogenous retinal detachment treated by vitrectomy in Ophthalmology Hospital of Qingdao University Medical College were randomly divided into 23G group and 20G group. All the operations were performed by the same physician and the indexes were observed and compared. Results: 1. Visual acuity: the final corrected visual acuity was significantly improved than before (P0.01), visual acuity improved in addition to 7 days, 15 days there was a difference (P0.05), other time between the two groups no significant difference (P0.05). 2. IOP: 3 cases in 23G group and 1 case in 20G group had intraocular pressure 21 mm Hg on the 1st day after operation. There was no significant difference in intraocular pressure between the two groups before and after operation (P0.05). Operation time: there was no significant difference in total operation time between the two groups (P0.05). 4. Corneal curvature: the corneal curvature in 20G group was significantly higher than that in preoperative group at 1 week and 4 weeks (P0.05), while in 23G group only 1 week after operation was significantly higher than that before operation (P0.05). Anterior segment inflammatory reaction: 23 G group of anterior segment inflammation degree than 20 G group light (P0.05). Lacrimal film stability: the early postoperative corneal fluorescence staining, tear film rupture time and tear secretion in 20G group were significantly different from those in 23G group (, (P 0. 05). Patient comfort: 20G group of patients with foreign body feeling, dry sense, tears than 23G group heavy (P0.05), eye pain, eye itching, eye secretion is no significant difference (P0.05). Incision complications: there was no significant difference in vitreous incarceration and proliferation between the two groups (P0.05). Postoperative complications: temporary low intraocular pressure and high intraocular pressure in both groups, retinal detachment in 1 case in 20 G group, incision microleakage in 1 case in 23 G group, and no endophthalmitis in both groups. Conclusion: the two surgical methods are effective in the treatment of primary rhegmatogenous retinal detachment. The 23G operation is characterized by small incision, quick wound recovery, light inflammatory reaction, less complications, and mild symptoms of discomfort in patients, but the incision is autistic because of 23 C vitreous surgery. Postoperative incision leakage, the risk of endophthalmitis.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R779.6

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