开放性眼外伤患者玻璃体手术时机的选择  

Timing of surgery in patients with open-globe injury

作　　者：陈回兴 廖海兰[1] 龙巧燕[1] 

机构地区：[1]深圳市龙岗区人民医院眼科,广东深圳518172

出　　处：《中国中医眼科杂志》2017年第2期119-121,共3页China Journal of Chinese Ophthalmology

摘　　要：目的探讨手术时机对开放性眼外伤患者玻璃体手术效果的影响。方法 2015年3月—2016年3月我院眼科收治的开放性眼外伤患者124例纳入研究,按照二期玻璃体手术时机的不同分为早期手术组(60例60只眼)和常规手术组(64例64只眼),分别在伤后2~4 d与伤后7~14 d内行玻璃体手术治疗,对比两组患者的手术疗效、并发症等情况。结果早期手术组60只眼,功能痊愈54只眼(90.00%),解剖痊愈4只眼(6.67%),未愈2只眼(3.33%),总痊愈率96.67%;常规手术组64只眼,功能痊愈38只眼(59.38%),解剖痊愈14只眼(21.88%),未愈12只眼(18.75%),总痊愈率81.25%。早期手术组的功能痊愈率、总痊愈率均明显好于常规手术组(功能痊愈率比较,χ~2=15.169,P<0.001;总痊愈率比较,χ~2=7.349,P=0.007)。早期手术组保留眼球58例(96.67%),常规手术组保留眼球60例(93.75%),组间比较无明显差异(连续性校正χ~2=0.114,P=0.736)。早期手术组患者术后的硅油依赖、视网膜脱离、玻璃再出血、继发性青光眼、外伤性增殖性玻璃体视网膜病变(TPVR)发生率均明显低于常规手术组(P<0.05)。结论开放性眼外伤患者早期行手术治疗能够有效提高治疗效果,减少相关并发症的发生,改善患者预后,是治疗开放性眼外伤的最佳手术时机。OBJECTIVE To investigate the clinical effect of surgery in different time of patients with open-globe injury. METHODS From March of 2015 to March of 2016, 124 cases with open-globe trauma admitted in our hospital were included and assigned into early surgery group（n=60） that accepted surgery 2-4 days after injury and conventional surgery group（n =64） that underwent procedure 7-14 days after trauma. Then results in terms of treatment efficacy and complications were compared between two groups after surgical treatment. RESULTS Functional recovery rate and the total cure rate of early surgery group were 90% and 96.67%, and they were significantly higher than counterparts of the conventional surgery group which were 59.38% and 81.25%（ P〈0.05）. The anatomical recovery rate and unhealed rate in early surgery group（6.67%, 3.33%） showed no statistical difference in contrast to conventional surgery group（21.88%, 18.75%）. In early surgery group, 58 cases（96.67%） saved their eyeballs,while in conventional surgery group 60 cases（93.75%） retain the eye which meant no difference between the two groups（P〈0.05）. After surgery, occurrence rates of silicone oil, retinal detachment, vitreous re-bleeding, secondary glaucoma, TPVR（trauma proliferative vitreoretinopathy） in early surgery group were significantly lower than in con-ventional surgery group（P〈0.05）. CONCLUSIONS Early surgical treatment of open-globe injury effectively improved the treatment effect, reduced the incidence of related complications, improved the prognosis of patients,therefore it was the best option for open-globe injury cases.

关 键 词：手术时机 玻璃体 开放性眼外伤 并发症 

分 类 号：R779.6[医药卫生—眼科]