青少年玻璃体视网膜手术现状分析

发布时间：2018-08-08 14:03

【摘要】：目的：研究分析青少年患者行玻璃体视网膜手术治疗的临床特点,对手术相关的各因素综合评价,指导后续临床工作。方法：收集我院2006年1月至2010年12月间的年龄小于或等于18岁玻璃体切割术治疗的青少年患者47例48眼,对其相关临床资料行统计分析。依据病因不同分为两组：原发性玻璃体视网膜病变组25例26眼,外伤性玻璃体视网膜病变组22例22眼。对其发病原因,手术方式,术中相关处置及预后进行分析讨论。结果：全部病例中引发玻璃体视网膜疾病的主要原因为外伤,外伤性玻璃体视网膜病变占46.8%(22眼)。主要病理改变为视网膜脱离共37眼(77.1%)。青少年患者术前增殖型玻璃体视网膜病变(proliferative vitreous retinopathy PVR)高发(36.1%),玻璃体后脱离(posterior detachment of vitreous PVD)发生率相对低(14.5%)。视网膜脱离范围广泛,大于两象限以上者占62.1%且多累及黄斑区(59.4%)及颞侧网膜(67.5%)。术中晶状体切除和／或联合人工晶体植入共9例,经统计分析其并不影响预后视力。视网膜脱离范围、脱离累及黄斑区及手术次数与预后视力行统计学分析,显示上述因素对预后视力影响显著。结论：1、青少年患者行玻璃体切割术(pars plana vitrectomy PPV)治疗主要原因为修复各型视网膜脱离,及伴发的不同程度的PVR。2、对于青少年患者PPV手术是否联合行晶状体处置应根据具体情况谨慎选择,对于预期可能行多次手术完成眼部解剖及功能修复的应尽量选择二期甚至三期手术。3、对于远期预后视力的主要影响因素为视网膜脱离范围,脱离是否累及黄斑区及手术频次。4、各病理因素引起的原发性疾病多数情况复杂,视网膜脱离范围广泛,手术复位难度较大且效果不佳,而外伤性玻璃体视网膜病变手术效果确切,预后视力相对理想。
[Abstract]:Objective: to analyze the clinical features of vitreoretinal surgery in adolescent patients and evaluate the related factors. Methods: from January 2006 to December 2010, 47 cases (48 eyes) of young patients under 18 years old treated by vitrectomy in our hospital were collected and their clinical data were analyzed statistically. The patients were divided into two groups according to the etiology: 25 cases (26 eyes) with primary vitreoretinopathy and 22 cases (22 eyes) with traumatic vitreoretinopathy. The etiology, surgical methods, intraoperative treatment and prognosis were analyzed and discussed. Results: trauma was the main cause of vitreoretinopathy in all cases. Traumatic vitreoretinopathy accounted for 46.8% (22 eyes). The main pathological changes were retinal detachment in 37 eyes (77.1%). The incidence of proliferative vitreoretinopathy (proliferative vitreous retinopathy PVR) was high (36.1%) and the incidence of posterior vitreous detachment (posterior detachment of vitreous PVD) was relatively low (14.5%). The range of retinal detachment was wide, more than two quadrants (62.1%), macular area (59.4%) and temporal omentum (67.5%). Intraoperative lens resection and / or intraocular lens implantation were performed in 9 cases. The range of retinal detachment, macular area and the number of operations and the prognosis of visual acuity were statistically analyzed. The results showed that the above factors had a significant effect on the prognosis of visual acuity. Conclusion the main reason for (pars plana vitrectomy PPV) treatment of adolescent patients with vitrectomy is to repair various types of retinal detachment. And PVR.2with different degrees of PVR.2. whether or not PPV surgery is combined with lens management should be carefully selected according to the specific situation. For those who are expected to undergo multiple operations to complete ocular anatomy and functional repair, the second or third stage operation should be chosen as far as possible. The main influencing factor for the long-term prognosis of visual acuity is the range of retinal detachment. Whether the detachment involved macular area and the frequency of surgery. 4. Most of the primary diseases caused by pathological factors were complicated, the range of retinal detachment was extensive, the surgical reattachment was difficult and the effect was not good. The operative effect of traumatic vitreoretinopathy is accurate, and the prognosis of vitreoretinopathy is relatively ideal.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R774.1

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