内下壁减压联合脂肪减压治疗中重度甲状腺相关眼病的疗效观察  

Medial-inferior wall orbital decompression combined with fat decompression in the treatment of moderate-tosevere thyroid associated ophthalmopathy

作　　者：王嫦君[1] 高涛[1] 张惠娜[1] 解佳隽 高琪 叶娟[1] WANG Changjun;GAO Tao;ZHANG Huina;XIE Jiajun;GAO Qi;YE Juan(Eye Center,The Second Affiliated Hospital,School of Medicine,Zhejiang University,Zhejiang Provincial Key Laboratory of Ophthalmology,Zhejiang Provincial Clinical Research Center for Eye Diseases,Zhejiang Provincial Engineering Institute on Eye Diseases,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院眼科中心,浙江省重要致盲眼病防治技术研究重点实验室,浙江省眼部疾病临床医学研究中心,眼部疾病浙江省工程研究中心,杭州310009

出　　处：《眼科学报》2023年第5期381-386,共6页Eye Science

基　　金：国家自然科学基金(82101178)~~。

摘　　要：目的:中重度甲状腺相关眼病内下壁骨性减压联合脂肪减压术的临床疗效观察。方法:回顾性分析25例(31眼)在浙江大学医学院附属第二医院眼科行内下壁骨性减压联合脂肪减压术治疗的甲状腺相关眼病患者,观察时间为2020年1月至2022年1月。术前所有患者均进行了眼眶CT检查,并对双眼视力、眼球突出、复视及双眼外观形态进行了测量。手术效果评价指标为:术后眼球突出度、视力和复视程度,并对相关数据进行统计和分析。结果:术后眼球突出度回退2~6 mm,平均回退(3.45±0.93)mm,切除眶内脂肪1.4~3.6 mL,平均切除(2.33±0.66)mL,外观恢复满意。4例患者术前存在复视,2例患者术后新发复视,术前已存在复视的患者,术后复视程度并未加重,新发的2例复视患者均为轻度复视。术后CT检查显示眼眶减压效果良好。结论:内下壁骨性减压与脂肪减压术联合,可以有效扩大眼眶容积,对眼球进行回纳,减少眼球突出程度,改善容貌外观,且手术切口隐蔽美观,具有较好的临床疗效果。Objective: To observe the clinical efficacy of medial-inferior wall orbital decompression combined with fat decompression in the treatment of moderate-to-severe thyroid associated ophthalmopathy (TAO). Methods: A retrospective analysis was performed on 25 patients (31 eyes) with moderate-to-severe TAO from January 2020 to January 2022 in Eye Hospital of Zhejiang University, who were treated with medial-inferior wall orbital decompression combined with fat decompression. All of patients were given orbital computed tomography to measure visual acuity, exophthalmos, diplopia and ocular appearance before operation. The preoperative and postoperative exophthalmos, visual acuity and diplopia before and after operation were taken as efficacy evaluating indicators. The related data was counted and analyzed statistically. Results: After operation, the reduction of exophthalmos was 2-6 mm, with an average of (3.45±0.93) mm, the volume of intrazonal fat-removal was 1.4-3.6 mL, with an average of (2.33±0.66) mL, with a satisfactory appearance. There were 4 cases of preoperative diplopia and 2 cases of new diplopia after operation, all of which were mild diplopia. Diplopia did not exacerbate after operation in the patients who had diplopia before operation. Conclusion: Medial-inferior wall orbital decompression combined with fat decompression in the treatment of moderate-to-severe TAO can effectively expand orbital volume, reduce exophthalmos, improve appearance with a concealed beautiful surgical incision, showing its good clinical efficacy.

关 键 词：眶减压 内下壁 脂肪减压 甲状腺相关眼病 

分 类 号：R771.3[医药卫生—眼科] R581[医药卫生—临床医学]