应用“三通道”自闭式巩膜隧道切口在20G玻璃体切割手术中的临床效果观察

发布时间：2018-03-17 12:17

本文选题：巩膜隧道切口　切入点：玻璃体切割　出处：《大连医科大学》2010年硕士论文　论文类型：学位论文

【摘要】： 目的：探讨“三通道”自闭式巩膜隧道切口用于20G玻璃体切割手术的可行性和应用效果。方法：选取我院从2008年3月至2009年6月期间对31例(31眼)经睫状体平坦部行后部标准20G玻璃体切割手术的患者,对于所有术中患者,沿角巩膜缘后1 mm做“倒L”形球结膜瓣,“三通道”切口采用自闭式巩膜隧道切口,手术操作结束时,先拔出光导纤维和玻切头,观察切口闭合情况,是否存在渗漏(如切口持续渗漏,则用10—0丝线间断缝合)最后拔出灌注管并平复隧道切口,再次观察切口有无渗漏(如切口有渗漏,仍按上述方法缝合)。球结膜切口电凝封闭。术后随诊4-19个月,同时记录术前、术后视力、眼压,切口闭合情况及术中、术后各种并发症。结果：31例手术均顺利完成,31眼93个巩膜隧道切口中,85个切口在手术结束时能自行闭合,8个切口则需行间断缝合,其中1例两个器械切口需全部缝合,6例需缝合1个器械切口。31个灌注隧道切口全部自行闭合,需缝合的隧道切口均为器械切口,在手术结束时予以处理。术后第一天检查,球结膜切口对合良好,球结膜下未见出血或少量不明显,球结膜充血水肿不明显,未见球结膜下的异常渗漏,术后2周对切口行UBM检查见自闭式巩膜隧道切口对合整齐,线状闭合。患者视力均有不同程度提高。随访病例无锯齿缘断离、周边视网膜裂孔及视网膜脱离发生,无玻璃体再次出血等并发症的发生结论：“三通道”巩膜隧道切口应用于常规20G玻璃体切割手术,具有眼球密闭好,术中眼压平稳,术后切口自闭型良好,术后炎症反应轻、恢复快,同时降低了因切口缝合而产生相关并发症等优点。手术术式安全、无明显术中术后并发症。在现阶段可以替代23G和25G实现无缝合的微创玻璃体切割手术,值得在临床应用。
[Abstract]:Objective: to investigate the feasibility and effect of three-channel self-closing scleral tunnel incision for 20 G vitrectomy. Methods: from March 2008 to June 2009, 31 patients (31 eyes) underwent posterior standard 20G vitrectomy through the flat part of the ciliary body. The "inverted L" conjunctival flap was made 1 mm behind the edge of the horn sclera. The "three-channel" incision was made with the self-closing scleral tunnel incision. At the end of the operation, the optical fiber and the glassy head were pulled out first, and the closure of the incision was observed. Whether there is leakage (if the incision continues to leak, by intermittent suturing with 10-0 filaments) and finally pulling out the perfusion tube and leveling the tunnel incision, and observing again whether there is leakage in the incision (if there is leakage in the incision, The conjunctival incision was closed by electric coagulation. The postoperative follow-up was 4 to 19 months. The preoperative and postoperative visual acuity, intraocular pressure, incision closure and complications were recorded. Results of the 93 scleral tunnel incisions in 31 eyes successfully completed in 31 cases, 85 incisions could be closed by themselves at the end of the operation, and 8 incisions needed to be sutured intermittently. Among them, 1 case with two instrument incisions needed to be sutured completely and 6 cases needed to suture 1 instrument incision. All 31 perfusion tunnel incisions were closed by themselves, and all the tunnel incisions needed to be sutured were instrumentation incisions, which were treated at the end of operation, and examined on the first day after operation. The bulbar conjunctiva incision had good involution, there was no bleeding or small amount of subconjunctival hemorrhage, no obvious hyperemia and edema, no abnormal leakage under the bulbar conjunctiva. 2 weeks after operation, UBM examination of the incision showed that the osseous scleral tunnel incision was involuted neatly, and the conjunctival hyperemia edema was not obvious. Linear closure. The visual acuity of the patients were improved in varying degrees. There were no complications such as serrated edge breakage, peripheral retinal rupture and retinal detachment, no vitreous rebleeding and so on. Conclusion: the application of "three-channel" scleral tunnel incision in routine 20G vitrectomy has good eye closure, stable intraoperative intraocular pressure, good self-closing incision after operation, light inflammatory reaction after operation and quick recovery. At the same time, it can reduce the advantages of complications caused by incision suture. The operation is safe and has no obvious postoperative complications. It can replace 23G and 25G to realize seamless minimally invasive vitrectomy at the present stage, which is worthy of clinical application.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.6

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