体外观察冷冻头冻附巨大非磁性物体及兔眼内冷凝的视网膜损伤研究

发布时间：2018-05-29 22:20

本文选题：眼内冷凝 + 巨大非磁性球内异物　；参考：《天津医科大学》2013年硕士论文

【摘要】：目的通过冷冻头及异物镊于体外摘取巨大非磁性物体的实验研究,比较异物镊与冷冻头的摘取效果,分析利用冷冻头的冻附力来摘取非磁性物体的适用范围,并进一步探索影响冷冻头冻附能力的影响因素。通过动物实验观察不同眼内冷凝量对视网膜视觉功能的影响,观察手术后1周、3周组织损伤和恢复的情况,探讨以冷冻头冻附物体来摘除眼内异物的可行性。方法 1.选取不同材质、不同质量的巨大非磁性物体分别置于盛有BBS液的小杯及0.32%琼脂凝胶表面,使用异物镊及18G、20G冷冻头分别尝试摘取物体,比较三种器械摘取巨大非磁性异物的效率,观察不同器械对琼脂的损伤,并探索利用冷冻头的冻附力摘取非磁性物体的适用范围。 2.选取不规则的钢化玻璃碎片,置于盛有BBS液的小杯中,模拟眼内灌注,使用20G冷冻头冻附玻璃。实验中控制单一变量,分别记录不同质量的玻璃、不同直径的灌注头、不同的灌注瓶高、不同的灌注角度、不同的灌注头与玻璃间距下冷冻头成功冻附物体的频数,研究影响冷冻头冻附能力的因素。 3.选取体重1.5-2.0kg的成年新西兰大白兔27只,随机分为3组,每组9只进行眼内冷凝手术, A组冷凝量为玻璃体腔冷冻结冰5秒,B组冷凝量为视网膜表面冷冻结冰5秒,C组冷凝量为玻璃体腔冷冻结冰10秒。术前、术后1周、术后2周、术后3周分别行闪光电生理检查,术后1周及3周行H-E光学显微镜检查,术后3周行透射电子显微镜检查。从视网膜视觉功能及组织形态两方面观察眼内冷凝对视网膜组织的影响。结果 1.异物镊摘取巨大非磁性物体的效率低,对琼脂有明显的挤压伤和划伤。使用20G冷冻头成功冻附了除铜以外的非磁性物体。18G冷冻头的摘除效率最高,但在冻附铜的解冻过程中,琼脂冻伤明显。 2.实验数据采用独立样本R×C例联表的x2检验进行统计处理,其结果如下：使用20G冷冻头冻附质量不同的玻璃,其频数差异无统计学意义(P0.05),使用不同直径灌注头或在不同灌注瓶高的灌注下,20G冷冻头冻附玻璃的频数差异不显著(P0.05),灌注头以与玻璃呈0。、45。、145。角度下灌注,20G冷冻头冻附玻璃的频数差异有统计学意义(Z=17.199,P0.05)。灌注头以与玻璃5mm、10mm、15mm、20mm的间距下灌注,20G冷冻头冻附玻璃的频数差异显著(x2=12.480,P0.05)。 3.对F-ERG数据行析因设计的双因素方差分析,使用q检验对组间的均数进行两两比较。A、B、C三组暗适应b波潜时、振幅及震荡电位(osillatory potentials,OPs)总振幅比较,差异均有统计学意义(P0.05)；各组暗适应a波潜时及振幅差异无显著性(P0.05)。A、B、C三组术后1周暗适应a、b波潜时、振幅及OPs波总振幅与术前相比差异性显著(P0.05)。 4. H-E光学显微镜检查：术后1周B组玻璃体腔弥漫渗出物,神经节细胞水肿呈空泡状,光感受细胞层变性,损伤累及视网膜全层；A组损伤较轻,可见视网膜表面散在变性物质；C组玻璃体中可见红染渗出物及变性的血细胞,视网膜表面存在变性物质。手术后3周,三组均有不同程度的恢复,A组视网膜基本恢复正常。 5.透射电子显微镜检查：术后3周A组损伤最轻,损伤主要累及内丛状层,B组损伤最重,损伤累及视网膜全层组织,C组损伤达外丛状层,界与两者之间。结论 1.利用冷冻头冻附法摘除异物适用于非磁性非金属异物。20G冷冻头冻附物体的能力与物体的质量、灌注头直径及灌注瓶高度无关,与灌注头的灌注角度及灌注头与物体间间距有关。 2.单次小范围短时间的眼内冷凝对视网膜视觉功能损伤较小,利用冷冻头的冻附能力,使用20G冷冻头摘取巨大非磁性非金属眼内异物的方法具有可行性。 3.本研究的创新性在于首次提出利用冷冻头来摘除眼内异物,此方法简单、高效,实用性强。
[Abstract]:Purpose

In order to study the effect of freezing head and foreign body forceps on the removal of giant non - magnetic objects in vitro , the effects of freezing - attachment on retinal visual function were analyzed . The effects of different intraocular condensation on retinal visual function were investigated by animal experiments .

method

1 . The large non - magnetic objects with different materials and different qualities were respectively placed on a small cup containing BBS solution and 0.32 % agarose gel surface . Using foreign body forceps and 18G and 20 G cryotips respectively , we attempted to extract the objects , compare the efficiency of the three kinds of instruments to remove giant non - magnetic foreign materials , observe the damage of different devices to agar , and explore the application scope of the non - magnetic objects by using the frozen attachment force of the freezing head .

2 . The irregular toughened glass fragments were selected and placed in a small cup filled with BBS liquid to simulate intraocular perfusion . A single variable was used to control the different quality of glass , different diameter perfusion heads , different perfusion angles , different perfusion angles , different perfusion heads and glass spacing , the frequency of the frozen head was successfully frozen , and the factors affecting the freezing capacity of the frozen head were studied .

3 . Twenty - seven adult New Zealand rabbits weighing 1.5 - 2.0kg were randomly divided into 3 groups , group A was frozen for 5 seconds , group A was frozen for 5 seconds , group B was frozen for 5 seconds , group C was frozen for 5 seconds , group C was frozen for 5 seconds , group C was frozen for 5 seconds , group C was frozen for 5 seconds , group C was frozen for 10 seconds .

Results

1 . The efficiency of removal of giant non - magnetic objects by foreign body forceps is low , and there is obvious crush injury and scratch on agar . The removal efficiency of 18G freezing head is the highest , but in the process of thawing frozen copper , the agar frost injury is obvious .

2 . The experiment data was statistically treated with the x2 test of independent sample R 脳 C . The results were as follows : There was no significant difference ( P0.05 ) . The frequency difference was not significant ( P0.05 ) . The frequency difference was significant ( x2 = 12.480 , P0.05 ) .

3 . Two - factor variance analysis of F - ERG data line analysis was carried out , and the mean square of group A , B and C was compared with that of group A , B and C . The amplitude and the amplitude of the amplitude and the amplitude of the OPs were statistically significant ( P0.05 ) .
In group A , B and C , the amplitude and OPs wave amplitude were significantly different from those before operation ( P0.05 ) .

4 . H - E optical microscopy : 1 week after surgery , the vitreous cavity mass exudate , ganglion cell edema was vacuolar , the photoreceptive cell layer degeneration , the damage involved the retina whole layer ;
Group A was less damaged and the surface of the retina was scattered on the degenerative substance ;
In group C , red - stained exudate and denatured red blood cells were seen in the vitreous , and degeneration was found on the surface of the retina . Three weeks after surgery , three groups were recovered , and the retina of group A was restored to normal .

5 . Transmission electron microscope ( TEM ) : Group A was the most injured in 3 weeks after operation , and the injury was mainly involved in the inner and the inner series , and the damage was the heaviest in group B , the damage involved the whole retinal tissue , and the C group was damaged to the outer series , the boundary and the two .

Conclusion

1 . The freezing - tip freezing method was used to remove foreign bodies from non - magnetic non - metallic foreign bodies . The capacity of the frozen - head frozen - attached object was not related to the mass of the object , the diameter of the irrigation head and the height of the perfusion bottle , and the perfusion angle of the perfusion head and the space between the irrigation head and the object .

2 . It is feasible to extract giant non - metallic intraocular foreign matter using the frozen head of G G using the freezing and attaching ability of the frozen head and the freezing attachment ability of the frozen head .

3 . The innovation of this study is that the freezing head can be used to remove the intraocular foreign matter for the first time . This method is simple , efficient and strong in practicability .
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R779.6

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