双眼外直肌后徙术和单眼一退一截术治疗儿童基本型或假性外展过强型间歇性外斜视的疗效比较  

Analysis and comparison of bilateral lateral rectus recession and unilateral recession resection for basic or pseudo-divergence excess type intermittent exotropia

作　　者：宋德胜[1] 陈霞[1] 

机构地区：[1]天津市眼科医院天津医科大学眼科临床学院天津市眼科研究所天津市眼科学与视觉科学重点实验室,天津市300020

出　　处：《眼科新进展》2016年第9期867-869,共3页Recent Advances in Ophthalmology

摘　　要：目的比较双眼外直肌后徙术（bilateral lateral rectus recession，BLR-rec）与单眼一退一截术（unilateral recess-resect．R＆R）治疗儿童基本型或假性外展过强型间歇性外斜视的疗效。方法研究对象为2013年至2015年在我院进行手术治疗的基本型或假性外展过强型间歇性外斜视患者，其中38例行BLR-rec，48例行R＆R。采用三棱镜加交替遮盖法测量患儿戴镜注视6m及33cm调节性视标第一眼位斜视度。分析两组术后1d、1个月、6个月、12个月及末次随访时的手术成功情况。记录比较两种术式的疗效，并分析影响手术成功率的因素。结果术后1d、1个月、6个月、12个月及末次随访时，BLR-Fee组与R＆R组手术成功率差异均无统计学意义（均为P〉0．05），术后1个月开始，两组手术成功率均不断降低。两组最大外斜视度数漂移均发生在术后1d至术后1个月之间，术后1d至术后1个月外斜漂移量BLR组为5．3△±4．4△，R＆R组为5．0△±4．1△（P：0．88）。BLR组术后1d到术后1a外斜漂移量为7．9△±5．1△，R＆R组为11．5△±8．3△（P〈0．01）。两组手术年龄和术前斜视度对末次随访手术成功率无明显影响。BLR-ree组和R＆R组术后1d不同斜视度范围的末次随访时手术成功率差异均无统计学意义（均为P〉0．05）。结论BLR—rec与R＆R治疗基本型或假性外展过强型间歇性外斜视有相同的远期手术成功率，随随访时间增加，两组手术成功率不断降低，主要原因为外斜回退。两种术式对间歇性外斜视外斜回退的影响明显不同，R＆R能引起更多的外斜漂移量。Objective To compare the long-term outcomes of bilateral lateral rectus recession （BLR-rec） and unilateral recession-resection （R＆R） in the treatment of patient with basic or pseudo-divergence excess intermittent exotropia. Methods Thirty-eight patients with basic or pseudo-divergence excess type of X（T） underwent BLR-rec and 48 patients underwent R＆R at a single center from 2013 to 2015 were retrospectively reviewed. The deviation degree of the first eye position at 6 m and 33 cm of regulatory vision was measured after diagnostic occlusion for 45 minutes by using prism plus alternating occlusion method. The surgical outcomes at postoperative 1 day, 1 month,5 months and 12 months and the last follow-up between groups were compared, and the effect factors on surgical successful rate was analyzed. Results There was no statistical difference in the success rate at postoperative 1 day, 1 month, 6 months, 12 months and the last follow-up between the two groups （ all P 〉 0.05 ）, but decreased with time from 1 month. The maximum exodrift amount of two groups appeared from the postoperative 1 day to 1 year,which in BLR group was 5.3^Δ±4.4^Δ,R＆R group was 5.0^Δ ±4.1^Δ,there was no statistical difference （P =0.88）. The average exodrift amount from the postoperative 1 day to 1 year in BLR group was 7.9^Δ±5. 1^Δ,RSaR group was 11. 5^Δ± 8.3^Δ ,there was statistical difference （P 〈0.01 ）. The surgical age and preopera- tive strabismus degree had no effect on the surgical successful rate at the fmal follow- up. There was no statistical difference in the surgical successful rate at the fmal follow- up within different strabismus degree at postoperative 1 day between two groups （all P 〉 0.05）. Conclusion BLR-rec and R＆R for basic or pseudo-divergence excess intermittent exotropia have the same long-term surgical successful rate, with the time increases, the successful rate in two groups gradually decrease, the main reason was the exotropia restore. Surgical outcomes differ sig

关 键 词：双眼外直肌后徙 间歇性外斜视 单眼一退一截术 治疗 

分 类 号：R777.41[医药卫生—眼科] R77[医药卫生—临床医学]