锯齿缘离断外路显微手术的临床观察.DOCVIP

临床医学论文-锯齿缘离断外路显微手术的临床观察 ????? 作者：张英，胡丕清，孙立新，朱学春，易银武，刘文 【摘要】? 目的? 探讨锯齿缘离断视网膜脱离外路显微手术的临床效果。方法? 对连续28例（30眼）锯齿缘离断视网膜脱离患者，采用在显微镜下预置硅胶块和（或）环扎带缝线、放视网膜下液、经巩膜冷凝视网膜裂孔，核对裂孔在手术嵴前的位置和眼内注气术。结果? 先放视网膜下液后，通过冷凝头的巩膜压陷，在手术显微镜直视下可清楚地看到冷凝视网膜裂孔的反应，裂孔定位均位于手术嵴前。术中并发症是排液孔视网膜下少量出血和角膜上皮剥脱各3眼，术后并发症主要是青光眼和再发视网膜脱离。一次手术后视网膜复位29眼（96.7%），再次外路显微手术1眼，术后视网膜全部复位。术后视力比术前有显著提高（P＜0.01）。结论? 应用视网膜脱离外路显微手术方法治疗锯齿缘离断视网膜脱离有着良好的手术效果。 ??? 【关键词】? 锯齿缘离断? 视网膜脱离? 显微手术 ??? Clinical observation of external approach microsurgery in ora serrata detachment ??????? 【Abstract】? Objective? To explore the effect of external approach microsurgery in ora serrata detachment. Methods? Consecutive 30 eyes of 28 patients with ora serrata detachment were enrolled in this study. The progresses of the external approach microsurgery were followed. Under the surgical microscopy， the preplacement of silicone and/or encircling following retrobulbar anesthesia and scleral exposure， draining subretinal fluid， the cryotherapy of retinal breaks， checking the position of breaks on scleral buckle and gas injection were performed in turn.Results? After drainage of subretinal fluid， with scleral depression cryotherapy reaction around breaks could be observed clearly under the microscopy. All breaks were located on anterior slope of the buckle. Intraoperative complications were mild subretinal hemorrhage at drainage site and corneal epithelium exfoliation in 3 eyes， respectively. Postoperative complications were mainly secondary glaucoma and retinal redetachment. The once-operation reattachmental rate was 96.7% (29 eyes)， and the final reattachmental rate was 100% after 1 eye had a second external approach microsurgery. The postoperative visual acuity(VA) was significantly better than the preoperative VA（χ2=9.529，P＜0.01).Conclusion? External approach microsurgery has remarkable effect on the surgery of ora serrata detachment. ???? 【Key words】? ora serrata detachment? retinal detachment? microsurgery ???? 视网膜脱离外路显微手术是通过手术显微镜直接观察眼底和进行视网膜脱离手术的一种新方法。