改良式23G硅油取出术的临床研究-第三军医大学学报.DOC

改良式23G硅油取出术的临床研究 A modified removal of silicone oil with 23-gauge transconjunctival vitrectomy system 第三军医大学野战外科研究所 眼科 吴鸣宇 叶剑 摘要 目的 比较传统经睫状体平坦部 23G免缝合切口硅油取出术与改良式23G硅油取出术的临床疗效及并发症。 方法 随机对照临床前瞻性研究。行硅油取出术的临床连续病例共 177例 (180 眼)，采用随机数表对患者分为2组，其中传统23G 免缝合切口硅油取出术组87例 (简称 A组，88 眼) 和改良式23G缝合切口硅油取出术组90例( 简称 B组，92眼)。术后平均随访时间为 3～6月，记录并分析两组的手术时间、术后视力、眼压变化和并发症情况。 结果 A组平均取油时间为7.24±1.66 min，B组为7.47±1.81 min，两组差异无统计学意义 (t = 1.95，P = 0.05)。术前、术后1d、1wk、3mo平均眼压分别为：A组18.07±4.23，12.23±4.42，14.69±3.21，15.14±3.0mmHg；B组17.86±3.73，13.78±3.72，15.37±3.09，15.61±2.91mmHg，术后1d两组平均眼压均较术前降低，两组间比较差异具有显著统计学意义（t = 2.55，P = 0.01），余时间点组间差异无统计学意义。随访期间，A组病例中发生术后低眼压25例（28.4 %）、脉络膜脱离8例（9.1 %），玻璃体积血5例（5.7 %），视网膜再脱离9例（10.2 %），术后残留硅油7例（8.0 %）；B组出现低眼压5例（5.4 %），脉络膜脱离2例（2.2 %）及玻璃体积血2例（2.2 %），视网膜再脱离8例（8.7 %），术后残留硅油1例（1 %）。其中两组术后低眼压、脉络膜脱离及硅油残留的发生相比较，差异具有统计学意义（P＜0.01、P = 0.04、P = 0.03）。 结论 改良式23G硅油取出术增加了预制缝线及两通道下气液交换步骤，有效降低了术后低眼压、脉络膜脱离、残留硅油小泡等并发症的发生，降低了手术风险，具有一定的临床应用意义。 关键词 硅油取出术后 低眼压 气液交换 Abstract Purpose: to investigate and compare the safety and efficacy of a modified technique for silicone oil removal with a traditional 23-gauge (23G) transconjunctival vitrectomy system. Methods: A randomized controlled clinical prospective study was performed for 177 patients (180 eyes), who once had pars plana vitrectomy combined with silicone oil tamponade underwent silicon oil removal. Patients were randomly separated into two groups: a traditional 23-gauge (23G) transconjunctival sutureless vitrectomy system group (A group, 87 patients 88 eyes) and a modified technique 23G transconjunctival vitrectomy system with incision sutured group (B group, 90 patients 92 eyes). The mean operation time and silicone oil removal time and preoperative and postoperative intraocular pressure (IOP) levels and visual acuity with the two groups were recorded and compared. Rate of retinal reattachment and complications were also compared during follow-up. Results: The mean operation time was 7.24±1.66 min in A group, and 7.47±1.81 min in B