巩膜扣带术失败病例再手术方式的选择和疗效观察

发布时间：2018-05-21 14:44

本文选题：巩膜扣带术 + 玻璃体切除术　；参考：《广西医科大学》2012年硕士论文

【摘要】：目的：研究巩膜扣带术失败原因和再次手术方式的选择方法手术效果。方法：回顾性观察60例（60眼）原发性孔源性视网膜脱离患者，第一次手术行巩膜扣带术，手术失败的病例。再次手术选择行巩膜扣带调整术、巩膜扣带术或玻璃体切除术。其中A组中30例（30眼）给予行巩膜扣带调整术或巩膜扣带术。B组30例（30眼）行玻璃体切割术。术后根据门诊病历资料进行随访观察6个月。术后观察视网膜复位情况、视力情况和手术后有无并发症等进行分析。用卡方检验分析比较两种手术方式的成功率、手术后视力提高情况和手术并发症的发生率，用配对秩和检验分析两次手术前PVR等级。结果：手术失败的60眼中,原裂孔未封闭28眼,出现新裂孔或遗漏裂孔24眼。A组30眼经二次手术后，，有22只眼视网膜达到解剖复位，成功率73.33%。B组30眼经二次手术后，有24只眼视网膜达到解剖复位，成功率80%。用卡方检验进行分析（X2=0.373P=0.5420.05），可以认为两种手术方式成功率差异无统计学意义。第2次手术前PVR级别较第1次加重（χ2=10.049，P=0.018,P0.05）。A、B两组术后视力提高差异进行卡方检验（χ2=0.800，P=0.3710.05）,可以认为两组术后的视力提高程度差别无明显统计学意义。对术后手术并发症进行卡方检验分析：高眼压(χ2=4.007，P=0.045)，两组间差异有统计学意义(P0.05)，B组发生此并发症高于A组。视物变形(χ2=9.603，P=0.002)，两组间差异有统计学意义(P0.05)， A组发生视物变形高于B组。结论：巩膜扣带术失败的主要原因是视网膜依然存在漏水的裂孔；二次手术方式的选择和手术操作是影响二次手术成功率的重要因素，我们应根据手术失败的原因、患者眼部情况、各种手术的优缺点等，同时以最小手术创伤为手术方式的选择原则；手术方式选择得当时，二次手术选择外路手术或玻璃体切除术，两者成功率无明显差异；二次手选择不当和手术操作不当将有可能导致再一次手术失败。
[Abstract]:Objective: to study the cause of failure of scleral buckling and the choice of reoperation method. Methods: 60 patients (60 eyes) with primary rhegmatogenous retinal detachment underwent scleral buckling for the first time. Reoperation is performed with scleral buckling adjustment, scleral buckling or vitrectomy. Group A (30 eyes) were treated with scleral buckling adjustment or scleral buckling. Group B (30 eyes) were treated with vitrectomy. The patients were followed up for 6 months according to the data of outpatient medical records. Postoperative retinal reattachment, visual acuity and postoperative complications were analyzed. Chi-square test was used to compare the success rate, visual acuity improvement and complication rate of the two operations. The PVR grade before two operations was analyzed by paired rank sum test. Results: among the 60 eyes with failed operation, 28 eyes had not been closed with the original hole. In group A, 30 eyes had new or missing hole, 22 eyes had anatomic reattachment after secondary operation, the success rate was 73.33.B group (30 eyes) after secondary operation. In 24 eyes, the retina was anatomically reattached, and the success rate was 80%. The chi-square test was used to analyze the success rate of the two surgical methods. The grade of PVR before the second operation was worse than that of the first (蠂 2 + 10.049) (蠂 2 + 10.049) P0. 018 (P 0. 05). The difference of postoperative visual acuity between the two groups was analyzed by chi-square test (蠂 2 + 0. 800 P 0. 3710.05). It can be concluded that there is no significant difference in the degree of visual acuity improvement between the two groups. The postoperative complications were analyzed by chi-square test: high intraocular pressure (蠂 2 + 4.007) was 0.045%. The difference between the two groups was statistically significant. The incidence of this complication in group B was higher than that in group A (P 0.05). Visual deformation (蠂 2 / 9.603) was significantly higher in group A than that in group B (P 0.05). Conclusion: the main reason for the failure of scleral buckling surgery is that there are still leaking holes in the retina, and the choice of the secondary operation mode and the operation procedure are the important factors affecting the success rate of the secondary operation. Eye condition, advantages and disadvantages of various operations, at the same time, the principle of choice of operation mode was minimal surgical trauma, at that time, there was no significant difference in the success rate between the two groups by external surgery or vitrectomy. Improper selection of the second hand and improper operation may lead to the failure of another operation.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R779.6

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