三种娩核方式在小切口非超声乳化白内障术中的临床观察  

Clinical observation on different nucleus delivery methods in small incision cataract surgery with non-phacoemulsification

作　　者：廖文江[1] 闫亚红[1] 刘贤升 欧阳君[1] 柯美魁 

机构地区：[1]九江市第一人民医院眼科,江西九江332000

出　　处：《现代预防医学》2014年第19期3640-3642,3648,共4页Modern Preventive Medicine

摘　　要：目的评价注水圈套器娩核法、水压娩核法和前房内劈核法三种不同娩核方式在小切口非超乳白内障手术中应用的特点和疗效。方法对327例（327眼）老年性白内障患者,随机分成三组,分别通过注水圈套器娩核法、水压娩核法和前房内劈核法完成娩核过程,观察记录娩核时间、术中并发症、术后d1角膜内皮水肿程度及术后视力,统计学处理差异。结果娩核时间：注水圈套器娩核法平均时间45s、水压娩核法平均时间34s和前房内劈核法平均时间65 s,三组的平均娩核时间差异均有统计学意义（P〈0.05）。注水圈套器娩核法和前房内劈核法的并发症主要表现为虹膜损伤和后囊膜破裂;水压娩核法则主要表现为前房出血。统计学分析,角膜水肿0-1级者：A组与B组、B组与C组差异均有统计学意义（P〈0.05）,A组与C组统计学处理差异无统计学意义（P〉0.05）。术后1d视力：A组与C组、B组与C组差异均有统计学意义（P〈0.05）,术后7d视力：只有B组与C组差异有统计学意义（P〈0.05）,术后1mo视力：三组间差异无统计学意义（P〉0.05）。结论水压娩核法术中并发症少,术后d1角膜内皮水肿发生率低,更适用于Ⅳ级以下的核娩出;前房内劈核法对Ⅳ级以上核的处理优势是明显的。Objective To compare the clinical effect and characteristics of lens loop extracting nucleus method,water irrigation and nucleus fragmentation within anterior chamber in small incision cataract surgery with non-phacoemulsification.Methods There were 327 cases（327 eyes） with senile cataract randomly divided into three groups,by the lens loop extracting nucleus method（group A）,water irrigation（group B） and nucleus fragmentation within anterior chamber（group C）,to complete the process of nucleus division.The time of nuclear removal,complication during operation,the degree of edema of corneal endothelium on the first day after the surgery and visual acuity after surgery were observed and recorded.Results The average extracting nucleus time was 45 s in lens loop（group A）;34 s in water irrigation（group B） and 65 s in manual fragmentation（group C）.The differences of average time are statistically significant（P〉0.05）,and the complications in lens loop and manual fragmentation mainly were iris trauma and posterior capsular rupture;the complication in the water irrigation was hyphema.Regarding corneal edema from 0 to 1 degree,the differences between group A and group B,group B and group C were statistically significant（P〈0.05）.The difference between group A and group C had no statistical significance（P〈0.05）.Regarding the visual acuity on the first day after surgery,the difference between group A and group C,group B and group C were statistically significant（P〈0.05）,The visual acuity on the 7th day after surgery：the difference between group B and group C were statistically significant（P〈0.05）.In terms of the visual acuity on 1 month after surgery：three groups had no statistically significant difference（P〉0.05）.Conclusion The water irrigation method has fewer complications with low incidence of corner edema,which is more preferable in removing the nuclear below Ⅳ grade.Manual fragmentation has obvious advantages in removing nuclear above Ⅳ grade.

关 键 词：注水圈套器娩核法 前房内劈核法 水压娩核法 小切口非超乳白内障手术 

分 类 号：R181.32[医药卫生—流行病学]