经结膜无缝线23G玻璃体切割手术在玻璃体视网膜疾病中的应用研究  

Application of transconjunctival sutureless 23G vitrectom y system for vitreoretinal diseases

作　　者：陈玄之[1] 苗晓晴[1] 黄文婕[1] 

机构地区：[1]广东省湛江中心人民医院眼科,524037

出　　处：《中华眼科医学杂志（电子版）》2014年第6期31-34,共4页Chinese Journal of Ophthalmologic Medicine(Electronic Edition)

摘　　要：目的观察经结膜无缝线23 G玻璃体切割手术治疗玻璃体视网膜疾病的临床疗效、适应证和并发症。方法收集2010年2月至2012年12月期间广东省湛江中心人民医院眼科15例（15只眼）玻璃体视网膜疾病患者的临床资料,进行回顾分析。其中,特发性黄斑裂孔者8例（8只眼）,特发性黄斑前膜者3例（3只眼）,视网膜静脉阻塞致玻璃体积血者4例（4只眼）,所有患者均采用经结膜无缝线23 G玻璃体切割手术进行治疗。具体术式,根据患者的病情行玻璃体切割＋前膜剥膜＋气液交换＋全氟丙烷（C3F8）气体眼内填充术。手术后对患者进行1~6个月的随访,平均随访时间为3个月。观察患者的手术时间、手术效果、眼压变化情况及手术切口愈合情况。结果手术中患者无特别不适,全部手术均顺利完成,手术时间较20 G系统明显缩短。23 G系统无需打开结膜而作巩膜切口,缝线固定灌注头可在术毕直接缝合巩膜及结膜切口。手术时间缩短为35~65min,平均约45 min。23 G系统手术切除效率类似于20 G手术,所有手术操作步骤均能按术者意愿顺利完成,无套管滑脱、弯曲情况发生,操作过程无损伤晶状体和视网膜的异常情况发生。15例（15只眼）玻璃体视网膜疾病患者中,有12例（12只眼）患者结膜下有来自于巩膜浅层的轻微出血,用棉签轻轻按压后自然止血;3例（3只眼）患者结膜下有气泡,将结膜复位并轻轻按压后气泡渗漏停止,无需缝合,且已渗漏的气体在5 d后全部吸收。所有患者在随访期内未发生持续性切口渗漏、长期低眼压、感染性眼内炎、医源性视网膜裂孔、视网膜脱离、脉络膜脱离及前段增生性玻璃体视网膜病变等并发症。术后第1天患者的平均眼压为（11.3±6.3）mm Hg（1 mm Hg=0.133 k Pa）;眼压低于8 mm Hg者4例（4只眼）,其中1例（1只眼）患者眼压为5.3 mm Hg,临床观察3 d后自行恢复正常;眼�Objective To retrospectively the clinical effectiveness, indications and complications of the transconjunctival sutureless 23G vitrectomy system for vitreoretinal diseases. Methods Medical records of 15 patients with vitreoretinal diseases who underwent transconjunctival sutureless 23G vitrectomy, epiretinal membrane stripping, air-fluid exchange or perfluoropropane （C3 Fs8） gas intraocular tamponade in the Department of Ophthalmology, Zhanjiang People＇s Central Hospital, Guangdong between February,2010 and December,2012 reviewed. Data on the surgical time duration, surgical outcomes,intraocular pressure （ IOP）, and postoperative incision healing were analyzed. Results Of the 15 patients analyzed, 8 presented with idiopathic macular hole,3 with idiopathic macular epiretinal membrane and 4 with vitreous hemorrhage. Post- operative follow-up was performed for average of 3 （ rang from 1 to 6） months. The operation was successful in all cases under the 23G vitrectomy system. The operation duration ranged from 35 to 65 minutes with average of 45 minutes. The mean IOP wasl4. 0 - 3. 5 mmHg one week after operation, which was not significantly different from the preoperative level （ P 〉0.05 ）. The intraoperative complications included Mild hemorrhage under the conjunctiva was one of the intraoperative complications ,which occurred in 12 eyes but disappeared in a week. Conjunctival cyst was another complication, which occurred in 3 eyes but disappeared in five days. Ultrasound biomicroscopy at 2 weeks after operation revealed complete healing of the incision in the sclera. Optical coherence tomography and B-scan ocular ultrasound examinations at one month after operation showed full recoveries in all patients. Conclusion The transconjunctival sutureless 23 G vitrectomy system is an effective and safe surgical technique in the management of vitreorctinal diseases, with is associated with reduced operative time, faster postoperative recovery, better curative effect and less complications.

关 键 词：经结膜无缝线23 G玻璃体切割手术 黄斑疾病 玻璃体积血 评价 

分 类 号：R779.6[医药卫生—眼科]