分离性垂直斜视的再手术原因分析  

Evaluation of risk factors for re-operation cases with dissociated vertical deviation

作　　者：朱德海[1] 庞琳[1] 

机构地区：[1]北京大学第一医院眼科,北京100034

出　　处：《中国实用眼科杂志》2013年第8期1051-1054,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的观察分离性垂直斜视（dissociatedverticaldeviation，DVD）手术的远期效果及探讨再手术的原因。方法对施行DVD矫正术病例进行分析，比较和评定患者性别、年龄、不同手术方式等因素与再手术的关系。结果280例初次手术，年龄10个月至37岁，中位数6．5岁。学龄前儿童为145例（51．79％）；12岁以下总计236例。初次手术中226／280例（80．71％）为单眼手术。手术方式主要分为上直肌后徙术（89／280例）和下斜肌后徙转位术（191／280例）。35例做了第二次手术35／280（12．50％），年龄3-18岁，中位数6．5岁。两次手术间隔时间1—67个月，平均20．5个月。学龄前组再手术（28／145例）比例明显高于学龄患者（7／135例），占二次手术者的80．O％，无成年人。行上直肌手术者再手术原因最多见为继发对侧眼下斜肌亢进；行下斜肌手术者，再手术原因最多见为对侧眼的DVD合并下斜肌亢进。结论合理的手术设计可降低DVD再次手术率。Objective To investigate the long-term outcome of different surgery design for disso- ciated vertical deviation （DVD） and discuss the reasons of re-operation. Methods This was a retro- spective comparative study involving 315 patients with DVD. The correlation between gender, age, surgical design and re-operation rate were analyzed. Results In the 315 patients, 280 （88.89%） cas- es underwent surgery only once. The median age was 6.5 years old （range, 10 months to 37 years）, 236 patients （82.86%） were less than 12 years of age, in which, 145 （51.79%） patients were pre- schoolers （〈7 years of age）. Unilatetal surgery was performed in 226 cases. 35 of 315 cases （11.11%） underwent surgery twice. The median age was 6.5 years old similarly （range, 3 to 18 years）. The intervals between first and second surgery were from 1 to 67 months （mean, 20.51 months）. 80% of the re-operation cases were preschoolers. The re-operation rate of preschoolers was 19.3% （28 of 145 cases）, larger than that of school-age children （7 of 135 cases） and adults （0 of 12 cases）. Eighty-nine patients underwent superior rectus muscle recession （the group of rectus mus- cle surgery）, while 191 patients underwent inferior oblique muscle anterior displacement or recession （the group of oblique-muscle surgery）. In group of rectus muscle surgery, the most common reasons of re-operation was secondary inferior oblique overaction （IOOA） in the contralateral eye; while in group of oblique-muscle surgery, the main reason was DVD in the contralateral eye. Conclusions This finding suggests that properly selected surgery design can effectively lower the rate of re-opera- tion.

关 键 词：分离性垂直斜视 再手术 上直肌 下斜肌 

分 类 号：R777.41[医药卫生—眼科]