两步法巩膜穿刺在微创玻璃体切割手术中的应用  

Understanding of two-step sclerotomy used in microincision vitrectomy

作　　者：王东林[1] 苏燕[1] 颜世广 韩彦辉[1] 张春侠[1] 

机构地区：[1]济南市明水眼科医院,山东省济南市250200

出　　处：《眼科新进展》2015年第1期51-54,共4页Recent Advances in Ophthalmology

摘　　要：目的探讨两步法巩膜穿刺在微创玻璃体切割手术中的应用。方法回顾性分析2009年10月至2011年4月在我院行微创玻璃体切割手术的患者586例(586眼),手术全部应用23 G玻璃体切割系统,按其所接受的巩膜穿刺方式分为A组(一步法巩膜穿刺组)和B组(两步法巩膜穿刺组)。A组即应用23 G套管穿刺刀做巩膜穿刺,其他操作同常规手术。两步法巩膜穿刺在用23 G套管穿刺刀之前,预先用0.6 mm巩膜穿刺刀做巩膜穿刺,然后用23 G套管穿刺刀从预穿口进入,其他操作同常规手术。对比两种术式的手术效果。结果 A组平均每套套管穿刺刀使用3次,B组平均每套套管穿刺刀使用95次,B组平均每套使用次数是A组的31.7倍。A组术前、术后3个月视力和B组术前、术后3个月视力比较,差异均无统计学意义(均为P>0.05),两组术后3个月视力与手术前比较,差异均有统计学意义(均为P<0.01)。A组术后1 d和1周眼压分别为(12.69±5.84)mmH g(1 kP a=7.5 mmH g)和(14.30±4.03)mmH g,B组术后1 d和1周眼压分别为(13.13±5.28)mmH g和(14.80±3.44)mmH g,两组比较差异均无统计学意义(均为P>0.05),两组术后1 d和1周眼压与术前比较,差异均有统计学意义(均为P<0.05)。结论两步法巩膜穿刺微创玻璃体切割手术最大限度地降低了23 G套管穿刺刀穿刺的难度,增加了23G套管穿刺刀重复使用次数,节约了手术成本,减轻了患者的经济负担,为23 G微创玻璃体切割手术的广泛开展提供了更大优势。Objective To investigate the application of two-step sclerotomy used in micro-incision vitrectomy. Methods A total of 586 patients （586 eyes） received micro-incision vitrectomy from October 2009 to April 2011 were retrospectively studied. 23 Gauge vitrectomy system was used in all surgery. Patients were divided into group A （ one-step sclerotomy） and B （ two-step sclerotomy） according to the way of sclerotic puncture they undergone. In group A,23 Gauge bolster puncture knife was used for sclerotic puncture. The other operations were similar to conventional surgery. In two-step sclerotomy,prior to using 23 Gauge bolster puncture knife, sclerotic puncture was performed with 0.6 mm sclerotic puncture knife beforehand. Then,23 Gauge bolster punc- ture knife penetrated the sclera from the pre-sclerotic incision. The other operations were similar to conventional surgery. Results 23 Gauge bolster puncture knife could be reused three times averagely in group A and 95 times averagely in group B. The number of using bolster puncture knife was 31.7 times compared with group A averagely. There was no significant difference of vision before and 3 months after operation compared with group A and group B （ all P 〉 0.05 ）. IOP were （ 16.34 ± 4.89） mmHg（ 1 kP = 7.5 mmHg） ,（12.69 ±5.84） mmHg,and （14.30 ±4.03） mmHg before operation and 1 day, 1 week after operation in group A, respectively, which in group B were （ 15.62 ± 4. 83 ） mmHg, （ 13. 13 ± 5.28 ） mmHg, and （ 14.80 ± 3.44 ） mmHg, respectively, the difference was not statistically significant （ all P 〉 0.05 ）. Compared with before operation, there were statistical differences in IOP at postoperative 1 day and 1 week （ all P 〈 0. 05 ）. Conclusion The application of 0.6 mm sclerotic puncture knife in micro-incision vitrectomy of two-step sclerotomy utmostly reduce the difficulty of sclerotic puncture by 23 Gauge bolster puncture knife and increase the reuse of 23 Gauge bolster puncture knife. The surgery costs are s

关 键 词：23G玻璃体切割系统 玻璃体切割术 两步法巩膜穿刺 

分 类 号：R779.6[医药卫生—眼科]