眼睑缝合术治疗甲状腺相关眼病的临床疗效观察  

Clinical investigation of tarsorrhaphy suture for treatment thyroid-associated ophthalmopathy

作　　者：罗清礼[1] 唐莉[1] 何为民[1] 

机构地区：[1]四川大学华西医院眼科,成都610041

出　　处：《中华眼科杂志》2005年第9期777-780,共4页Chinese Journal of Ophthalmology

基　　金：国家自然科学基金资助项目(30371518);高等学校博士学科点专项科研基金资助项目(C200057);四川省科技攻关项目基金资助项目(01SG04611)

摘　　要：目的探讨应用眼睑缝合术治疗严重甲状腺相关眼病的临床适应证和疗效。方法选择1990年1月至2004年6月于四川大学华西医院眼科就诊的17例不能用眼眶减压术或糖皮质激素治疗的甲状腺相关眼病所致的暴露性角膜炎、角膜溃疡患者和24例眼眶减压术或眼眶放射治疗后眼睑闭合不全的患者,其中9例行暂时性外侧眼睑缝合术、32例行暂时性全眼睑缝合术。35例患者根据眼部炎性反应的不同程度,分别口服泼尼松30～50mg/d,7d后逐渐减量直至停药。患者术后1～5个月剪开缝合,观察临床疗效。结果17例暴露性角膜炎、角膜溃疡的患者经眼睑缝合术和糖皮质激素治疗,术后2～5个月逐渐剪开眼睑缝合后,眼睑闭合完全,角膜炎和角膜溃疡痊愈,视力从术前手动至0.5提高到术后0.06～0.8,手术前、后视力比较差异有统计学意义(F=18.33,P<0.05);其中11例残留角膜云翳。24例经眼眶减压术或眼眶放射治疗后、眼睑仍闭合不全的患者,经眼睑缝合术和糖皮质激素治疗,术后1～3个月逐渐剪开眼睑缝合后,眼睑闭合完全,角膜炎痊愈,视力从术前0.1～0.7提高到术后0.4～1.2,手术前、后视力比较差异有统计学意义(F=27.98,P<0.05)。9例行暂时性外侧眼睑缝合术患者,视力从术前0.1～0.8提高到术后0.4～1.2,手术前、后视力比较差异有统计学意义(F=38.45,P<0.05)。32例行暂时性全眼睑缝合术患者,视力从术前手动至0.5提高到术后0.06～0.8,手术前、后视力比较差异有统计学意义(F=14.23,P<0.05)。结论眼睑缝合术是一种治疗甲状腺相关眼病眼睑闭合不全引起的暴露性角膜炎和角膜溃疡并发症的较好方法。Objective To evaluate the indication and effectiveness of temporary tarsorrhaphy suture for the treatement of severe thyroid-associated ophthalmopathy （TAO）. Methods From January 1990 to June 2004 total 41 cases were collected in the study which included 17 cases with exposure keratitis, corneal ulcer who couldn＇t use glucocorticoid and orbital decompression and 24 cases of conea exposure after orbital decompression and radiation therapy for patients with TAO. Temporary lateral tarsorrhaphy were performed to 9 of all of the patients and temporary total tarsorrharhy to 32 patients. According to difference of ophthalmic inflmmation glucocorticoid was used in 35 cases starting with the doses of 30 - 50 mg and taper off. Tarsorrhaphy suture was opened in 1 - 5 months postoperation. Clinical effectiveness of the treatnmet was observed. Results Visual acuity （VA） was significant improved from preopetation HM -0. 5 to postoperation 0. 1 - 0. 8 （ P 〈 0. 05 ） in 17 cases of TAO after tarsorrharhy and taking corticosteroids. Eyelids were be able to close, keratitis and ulcer were healing. However cornea scar was found in 11 cases. Eyelid closed completely without corneal exposure after tarsorrhaphy in 24 cases of orbital decompression and radiation therapy. VA was improved from preopetation 0. 1 - 0. 7 to postoperation 0. 4 - 1.0 with significant difference（P 〈 0. 05）. VA of paitients underwent temporary lateral tarsorrhaphy was significant improved as well as VA of those underwent temporary total tarsorrharhy （ P 〈 0. 05 ）. Conclusion It may be a better choice to use tarsorrharhy suture for the treatment of TAO patients with corneal exposure and ulcer. （Chin J Ophthalmol , 2005,41 ： 777-780 ）

关 键 词：眼睑缝合术 甲状腺相关眼病 角膜溃疡 暴露性角膜炎 糖皮质激素 

分 类 号：R779.6[医药卫生—眼科]