外伤性睫状体解离复位手术失败的原因分析  

Causes of unsuccessful cyclopexy in traumatic cyclodialysis

作　　者：周军[1] 庞秀琴[1] 刘毅[1] 王绍莉[1] 何雷[1] 赵萌[1] 

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心眼科学与视觉科学北京市重点实验室,100730

出　　处：《眼科》2015年第4期246-249,共4页Ophthalmology in China

摘　　要：目的分析外伤性睫状体解离复位手术失败的原因。设计回顾性病例系列。研究对象2002年3月-2014年7月北京同仁眼科中心就诊的至少接受过1次睫状体复位手术、术后仍存在睫状体离断口的外伤性睫状体解离患者55例(55眼)。方法采用超声生物显微镜(UBM)检查确认睫状体离断口是否存在及其范围。根据既往手术记录,术前检查及术中所见,将手术失败原因分为缝针稀疏、缝合范围不足、缝合位置错误、假缝合4种。对在同仁医院及非同仁医院实施手术的比例也进行统计分析。主要指标手术失败原因的构成比。结果 55眼中手术失败73眼次。其中缝针稀疏23眼(31.5%),缝合范围不足22眼(30.1%),缝合位置错误15眼(20.6%),假缝合13眼(17.8%)。实施手术同仁医院组与非同仁医院组的缝合位置错误分别是1眼(4.1%)、14眼(28.6%)(P=0.01);假缝合分别是8眼(33.3%)、5眼(10.2%)(P=0.02)。55例患者中存在低眼压54例(98.2%)、浅前房32例(58.2%)。结论缝针稀疏、缝合范围不足、缝合位置错误、假缝合是外伤性睫状体解离复位手术失败的原因。缝合位置错误在基层医院手术失败的原因中更为突出。Objective To investigate the causes of unsuccessful surgical approach in traumatic cyclodialysis. Design Retrospective cases series. Participants 55 cases（55 eyes） of cyclodialysis underwent at least one time unsuccessful cyclopexy from 2002 March to 2014 July. Methods The clefts were confirmed with ultrasonic biological microscopy（UBM）. According to the previous operation records, preoperative examinations and the findings of the re-surgical procedures, causes of surgical failure were classified into 4 groups： suturing with wider apart, inadequate cover of the cleft, uncorrected suturing site and pseudo-suturing. Failure rates in different hospitals performed surgery were also compared. Main Outcome Measures The constituent ratio of unsuccessful causes of cyclopexy. Results There were 73 eyes suffered from deferent failure cases. In all failure 73 eyes, 23 eyes（31.5%） were suturing with wider apart, 22 eyes（30.1%） inadequate cover of the cleft, 15 eyes（20.6%） wrong suturing site, and 13 eyes（17.8%） pseudo-suturing. The number of eyes with wrong suturing site between Beijing Tongren Hospital group and other hospital group were 1 eye（4.1%）, 14 eyes（28.6%）（P=0.01）. The number of eyes with pseudo-suturing between Beijing Tongren Hospital group and other hospital group were 8 eye（33.3%）, 5 eyes（10.2%）（P=0.02）. In all 55 cases, 54 cases（98.2%） presented hypotension, and 32 cases（58.2%） presented shallow anterior chamber. Conclusions Major causes of unsuccessful cyclopexy in traumatic cyclodialysis include suturing with wider apart, inadequate cover of the cleft, unsuccessful suturing site and pseudo-suturing. Wrong suturing site is a predominant concern in cases from primary ophthalmic units.

关 键 词：外伤性睫状体解离 外科学 

分 类 号：R779.6[医药卫生—眼科]