重视继发性外斜视的手术治疗  

Pay attention to the surgical treatment of secondary exotropia

作　　者：曾璐莎 李俊红 Zeng Lusha;Li Junhong(First Clinical Medical College,Shanxi Medical University,Taiyuan 030001,China;Strabismus and Pediatric Ophthalmology,Shanxi Eye Hospital,Eye Hospital affiliated to Shanxi Medical University,Taiyuan 030002,China)

机构地区：[1]山西医科大学第一临床医学院,太原030001 [2]山西省眼科医院斜视与小儿眼科,山西医科大学附属眼科医院,太原030002

出　　处：《中华眼科医学杂志（电子版）》2023年第6期321-325,共5页Chinese Journal of Ophthalmologic Medicine(Electronic Edition)

基　　金：山西省卫生健康委科研课题(2020040);山西省眼科医院院内创新基金(C202202)。

摘　　要：继发性外斜视分为知觉性外斜视、连续性外斜视及复发性外斜视,其手术方式分为一次、二次及以上手术.知觉性外斜视者多一眼视力不佳常采用一次手术,小中斜视度者可行内直肌缩短联合外直肌后徙术,大斜视度者可行联合斜肌减弱术.连续性外斜视及复发性外斜视的二次手术取决于首次手术方式,单侧或双侧外直肌后徙者可行单侧或双侧内直肌缩短;单侧或双侧内直肌缩短者可行单侧或双侧外直肌后徙,单侧外直肌后徙联合内直肌缩短者可行对侧眼同样的术式.单侧外直肌后徙和内直肌前徙术成功率高.内直肌移位术和切除瘢痕组织术等新方法有效.术中将内直肌前移至原附着点前1 mm处的改进方法更为安全.眶外侧切开的新型手术入路能够处理困难病例,术前磁共振的应用、切除瘢痕组织行病理学检验、术中对肌肉注射药物有助于手术方式的设计.Secondary exotropia is divided into perceptual exotropia, continuous exotropia, and recurrent exotropia, and its surgical methods are divided into primary, secondary, and above surgeries. Patients with perceptual exotropia who have poor vision in one eye often undergo a single surgery. Patients with small to moderate strabismus may undergo internal rectus muscle shortening combined with external rectus muscle recession, while those with high strabismus may undergo combined with oblique muscle weakening surgery. The secondary surgery for continuous exotropia and recurrent exotropia depends on the initial surgical approach. For patients with unilateral or bilateral recession of the external rectus muscle, unilateral or bilateral shortening of the internal rectus muscle is feasible. For patients with unilateral or bilateral shortening of the inner rectus muscle, unilateral or bilateral recession of the outer rectus muscle can be performed. For patients with unilateral recession of the outer rectus muscle combined with shortening of the inner rectus muscle, the same surgical procedure can be performed on the opposite eye. The success rate of unilateral external rectus recession and internal rectus recession surgery is high. New methods such as internal rectus muscle transfer and scar tissue resection are effective. The improved method of moving the internal rectus muscle forward to 1 mm in front of the original attachment point during surgery is safer. The new surgical approach of lateral orbital incision can handle difficult cases, and the application of preoperative magnetic resonance imaging, pathological examination of scar tissue removal, and intramuscular injection of drugs during surgery are of great benefit to design of surgical methods.

关 键 词：继发性外斜视 知觉性外斜视 眼外科手术 

分 类 号：R779.6[医药卫生—眼科]